Long-term therapy with β-blockers, angiotensin-converting enzyme inhibitors (ACEIs), or angiotensin receptor blockers (ARBs) appears to be beneficial for patients with aortic dissection (AD), according to the findings of a recently published retrospective population-based cohort study.

The study authors obtained data from the National Health Insurance Research Database in Taiwan to determine whether there was an association between long-term therapy with various antihypertensive medications and late patient outcomes. The study analyzed data on 6978 adults with a first-ever AD who were discharged from the hospital between January 1, 2001, and December 31, 2013, and who also received a prescription for an ACEI, ARB, β-blocker, or ≥1 other antihypertensive drug (control group) up to 90 days after discharge. The primary outcomes of the study included all-cause mortality, death caused by aortic aneurism or dissection, later aortic operation, major adverse events (cardiac, cerebrovascular), readmission to the hospital, and new-onset dialysis.

Of the total patients included in the study, the majority received a β-blocker (n=3492), while approximately the same number of patients received an ACEI/ARB (n=1729) or another antihypertensive agent (n=1757). The authors noted, “Compared with patients in the other 2 groups, those in the β-blocker group were younger (mean [SD] age, 62.1 [13.9] years vs 68.7 [13.5] years for ACEIs or ARBs and 69.9 [13.8] years for controls) and comprised more male patients (2520 [72.2%] vs 1161 [67.1%] for ACEIs or ARBs and 1224 [69.7%] for controls).” 

The study authors reported the prevalence of medicated hypertension to be 60.1% for the ACEI/ARB group, 51.0% for the control group, and 45.2% for the β-blocker group. “Patients who underwent surgery for type A aortic dissection were more likely to be prescribed β-blockers (1134 patients [32.5%]) than an ACEI or ARB (309 patients [17.9%]) or another antihypertension medication (376 patients [21.4%]),” the authors added.

No significant differences were observed in any clinical characteristics among the treatment groups following adjustment for multiple propensity scores. Additionally, no differences were seen in the risks for all outcomes between the ACEI/ARB and β-blocker groups.

Findings of the analysis did show a significantly lower risk of all-cause hospital readmission for the ACEI/ARB group (subdistribution hazard ratio [HR], 0.92; 95% CI, 0.84-0.997) as well as the β-blocker group (subdistribution HR, 0.87; 95% CI, 0.81-0.94) compared with the control group. In addition, results showed a lower risk of all-cause mortality for the ACEI/ARB group (HR, 0.79; 95% CI, 0.71-0.89) and the β-blocker group (HR, 0.82; 95% CI, 0.73-0.91) compared with the control group. The authors noted that the risk of all-cause mortality was found to be lower in patients who received ARBs compared with those who received ACEIs (HR, 0.85; 95% CI, 0.76-0.95).

“Compared with the control group, the use of β-blockers and ACEIs or ARBs was associated with lower risks of mortality and hospital readmission due to any cause,” the authors concluded. “These data provide evidence that ACEI and ARB therapies may be alternatives to β-blocker use for the long-term treatment of AD.”


Chen S, Chan Y, Lin C, et al. Association of long-term use of antihypertensive medications with late outcomes among patients with aortic dissection [published online March 3, 2021]. JAMA Network Open. 2021;4(3):e210469. doi: 10.1001/jamanetworkopen.2021.0469.