Hypertension in Thoracic Aortic Dissection: A Meta-Analysis-Based Considerations in the Choice of Antihypertensive Agents

Abstract BACKGROUND Thoracic aortic dissection (TAD) is a potentially fatal condition. It has been linked with hypertension, and guidelines recommend antihypertensives. METHODS Electronic searches were conducted in MEDLINE and EMBASE with the following search strategy: ((“thoracic aortic dissection”[Mesh]) AND (“antihypertensive agents”[Mesh] from database inception to August 2024. RESULTS Hypertension is associated with a significant risk of TAD with a hazard ratio (HR) of 2.51 (95% CI: 1.75–3.60). Beta-blocker treatment produces a significant (P < 0.01) lower risk of an MACE HR of 0.55 (95% CI = 0.39-0.77). Angiotensin receptor blockers (ARBs) or ACE inhibitors also lower the risk of a major adverse cardiac event with a HR of 0.67 (95% CI = 0.58–0.78). Calcium channel blockers (CCB) significantly (P =0.0007) lowered MACE outcomes with a HR of 0.66 (95% CI = 0.53–0.84). A network meta-analysis was performed to evaluate the relative risk of aortic events associated with commonly prescribed antihypertensive agents, using beta-blockers (BB) as the reference comparator. Compared to BB, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACE/ARB) were associated with a non-significant increase in risk (HR 1.28, 95% confidence interval (CI): 0.91–1.81). CCB also demonstrated a non-significant reduction in risk (HR 0.68, 95% CI: 0.33–1.40) to BBs. CONCLUSIONS Hypertension is strongly associated with a risk of TAD. Beta-blockers are associated with the greatest reduction in MACE and remain the most effective first-line therapy for patients at risk of TAD. ACE inhibitors and ARBs also demonstrate benefit.