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 : the official journal of the European Society for Vascular Surgery Singh, T. P., Moxon, J. V., Gasser, T. C., Dalman, R. L., Bourke, M., Bourke, B., Tomee, S. M., Dawson, J., Golledge, J. 2022


This study was an unplanned exploratory analysis of a subset of participants from the Telmisartan in the Management of Abdominal Aortic Aneurysm (TEDY) trial, and 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.Participants with AAAs measuring 35 to 49mm in maximum diameter were randomised to receive telmisartan 40mg 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 and placebo using linear mixed effects models. These models were either unadjusted or adjusted for risk factors different in the groups at entry (p<0.100) or systolic blood pressure (SBP) at 1 year.One hundred and twenty four of the 207 participants recruited to TEDY were eligible for inclusion. The present study included 65 and 59 participants from the telmisartan and placebo group respectively. 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% Confidence intervals, CI -8.24, -0.14 kPa/year, p=0.043) and PWRI (-0.014 (95% CI -0.026, -0.001, p=0.032) compared to those allocated placebo after adjusting for risk factors. After adjustment for SBP at 1 year, telmisartan did not significantly reduce annual increase in PWS or PWRI.The findings of this study suggest that telmisartan limits the rate of increase in PWS and PWRI of small AAAs by reducing blood pressure.

View details for DOI 10.1016/j.ejvs.2022.07.042

View details for PubMedID 35944871