Effect of Telmisartan on the Peak Wall Stress and Peak Wall Rupture Index of Small Abdominal Aortic Aneurysms: An Exploratory Analysis of the TEDY Trial

Singh, Tejas P., Moxon, Joseph V., Gasser, T. Christian, Dalman, Ronald L., Bourke, Michael, Bourke, Bernie, Tomee, Stephanie M., Dawson, Joseph, Golledge, Jonathan, and TEDY investigators, (2022) Effect of Telmisartan on the Peak Wall Stress and Peak Wall Rupture Index of Small Abdominal Aortic Aneurysms: An Exploratory Analysis of the TEDY Trial. European Journal of Vascular and Endovascular Surgery, 64 (4). pp. 396-404.

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Objective: This study was an unplanned exploratory analysis of a subset of participants from the Telmisartan in the Management of Abdominal Aortic Aneurysm (TEDY) trial. It aimed to assess the efficacy of the angiotensin 1 receptor blocker telmisartan in reducing abdominal aortic aneurysm (AAA) peak wall stress (PWS) and peak wall rupture index (PWRI) among individuals with small AAAs.

Methods: Participants with AAAs measuring 35 – 49 mm in maximum diameter were randomised to receive telmisartan 40 mg or identical placebo in the TEDY trial. Participants who had computed tomography angiography performed at entry and at least one other time point during the trial (12 or 24 months) were included in the current study. Orthogonal AAA diameter, PWS, and PWRI were measured using previously validated methods. The annual change in PWS and PWRI from baseline was compared between participants allocated telmisartan or placebo using linear mixed effects models. These models were either unadjusted or adjusted for risk factors that were different in the groups at entry (p < .100) or systolic blood pressure (SBP) at one year.

Results: Of the 207 participants recruited to TEDY, 124 were eligible for inclusion in this study. This study included 65 and 59 participants from the telmisartan and placebo groups, respectively. The PWS and PWRI were not significantly different in the two groups at baseline. Participants allocated telmisartan had a slower annual increase in PWS (-4.19; 95% CI –8.24, –0.14 kPa/year; p = .043) and PWRI (–0.014; 95% CI –0.026, –0.001; p = .032) compared with those allocated placebo after adjusting for risk factors. After adjustment for SBP at one year, telmisartan did not significantly reduce annual increases in PWS or PWRI.

Conclusion: The findings of this study suggest that telmisartan limits the rate of increase in PWS and PWRI of small AAAs by reducing blood pressure.

Item ID: 76572
Item Type: Article (Research - C1)
ISSN: 1532-2165
Keywords: Abdominal aortic aneurysm, Biomechanics, Peak wall stress
Copyright Information: © 2022 Published by Elsevier B.V. on behalf of European Society for Vascular Surgery. All rights reserved.
Additional Information:

A full list of TEDY collaborators is provided in Appendix A. Supplementary data

Funders: National Health and Medical Research Council (NHMRC)
Projects and Grants: NHMRC 1079369, NHMRC 1022752, NHMRC Practitioner Fellowship 1117601
Date Deposited: 19 Apr 2023 02:33
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320226 Surgery @ 100%
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