Abstract
Aortic dissection is a life-threatening condition. However, the use of medication to treat it remains unclear in our population, particularly in patients with a type B aortic dissection (TBAD) who do not receive surgery. This retrospective cohort study evaluated antihypertensive prescription patterns and outcomes in patients with nonsurgical TBAD. We reviewed the hospital records of patients with TBAD at a medical center in Taiwan from January 2008 to June 2013 to assess the baseline information, prescribing pattern, event rate, and clinical effectiveness of different antihypertensive treatment strategies. A Cox proportional hazards model was used to estimate outcomes in different antihypertensive strategies. The primary endpoints were all-cause mortality and hospital admission for an aortic dissection. We included 106 patients with a mean follow-up period of 2.75 years. The most common comorbidity was hypertension followed by dyslipidemia and diabetes mellitus. Study endpoints mostly occurred within 6 months after the index date. Over 80% of patients received dual or triple antihypertensive strategies. Patients treated with different treatment strategies did not have a significantly increased risk of a primary outcome compared with those treated with a monotherapy. We found no significant difference in the primary outcome following the use of different antihypertensive medication regimes.
Highlights
An aortic dissection is a life-threatening condition that is associated with high rates of morbidity and mortality in both the developed and developing countries worldwide [1]
Medication is essential for controlling Type B aortic dissections (TBAD), the goals of which are to lower the systolic blood pressure (BP) and heart rate, slow the progression of the disease, and reduce the associated morbidity and mortality
The results revealed that patients with TBAD who were treated with different treatment strategies during the follow-up did not have a significantly increased risk of a primary outcome compared with those treated with monotherapy, after adjusting for the following factors: age, gender, comorbidity, and important risk factors (Table 4)
Summary
An aortic dissection is a life-threatening condition that is associated with high rates of morbidity and mortality in both the developed and developing countries worldwide [1]. A Stanford classification type A aortic dissection involves the ascending aorta and requires surgery. TBAD can be clinically managed under most conditions, often without requiring surgery. The acute phase is defined as the 14-day period following the initial onset of symptoms because of high morbidity and mortality rates. A study revealed TBAD mortality rates to be 10.7% in patients who were treated with medication and 31.4% in patients who underwent surgery [1]. Medication is essential for controlling TBAD, the goals of which are to lower the systolic blood pressure (BP) and heart rate, slow the progression of the disease, and reduce the associated morbidity and mortality
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