Atenolol versus Losartan in Children and Young Adults with Marfan's Syndrome

被引：362

作者：

Lacro, R. V. ^{[1
]}

Dietz, H. C. ^{[2
]}

Sleeper, L. A. ^{[3
]}

Yetman, A. T. ^{[4
,5
]}

Bradley, T. J. ^{[6
]}

Colan, S. D. ^{[1
,3
]}

Pearson, G. D. ^{[7
]}

Tierney, E. S. Selamet ^{[1
]}

Levine, J. C. ^{[1
]}

Atz, A. M. ^{[8
]}

Benson, D. W. ^{[9
]}

Braverman, A. C. ^{[10
]}

Chen, S. ^{[3
]}

De Backer, J. ^{[11
]}

Gelb, B. D. ^{[12
]}

Grossfeld, P. D. ^{[15
]}

Klein, G. L. ^{[3
]}

Lai, W. W. ^{[13
]}

Liou, A. ^{[16
]}

Loeys, B. L. ^{[11
]}

Markham, L. W. ^{[17
]}

Olson, A. K. ^{[18
]}

Paridon, S. M. ^{[19
]}

Pemberton, V. L. ^{[7
]}

Pierpont, M. E. ^{[21
]}

Pyeritz, R. E. ^{[20
]}

Radojewski, E. ^{[6
]}

Roman, M. J. ^{[14
]}

Sharkey, A. M. ^{[10
]}

Stylianou, M. P. ^{[7
]}

Wechsler, S. Burns ^{[22
]}

Young, L. T. ^{[23
]}

Mahony, L. ^{[24
]}

机构：

[1] Boston Childrens Hosp, Boston, MA 02115 USA

[2] Johns Hopkins Univ, Sch Med, Baltimore, MD USA

[3] New England Res Inst, Watertown, MA 02172 USA

[4] Primary Childrens Med Ctr, Salt Lake City, UT USA

[5] Univ Utah, Salt Lake City, UT USA

[6] Hosp Sick Children, Toronto, ON M5G 1X8, Canada

[7] NHLBI, NIH, Bethesda, MD 20892 USA

[8] Med Univ S Carolina, Charleston, SC USA

[9] Cincinnati Childrens Med Ctr, Cincinnati, OH USA

[10] Washington Univ, Sch Med, St Louis, MO 63130 USA

[11] Ghent Univ Hosp, Ghent, Belgium

[12] Icahn Sch Med Mt Sinai, New York, NY 10029 USA

[13] Childrens Hosp New York, New York, NY USA

[14] Cornell Univ, Weill Med Coll, New York, NY 10021 USA

[15] Univ Calif San Diego, Rady Childrens Hosp, San Diego, CA 92103 USA

[16] Texas Childrens Hosp, Houston, TX 77030 USA

[17] Vanderbilt Univ, Sch Med, Nashville, TN 37212 USA

[18] Seattle Childrens Hosp, Seattle, WA USA

[19] Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA

[20] Univ Penn, Philadelphia, PA 19104 USA

[21] Childrens Hosp & Clin Minnesota, Minneapolis, MN USA

[22] Duke Univ, Med Ctr, Durham, NC USA

[23] Ann & Robert H Lurie Childrens Hosp Chicago, Chicago, IL USA

[24] Univ Texas SW Med Ctr Dallas, Dallas, TX 75390 USA

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2014年 / 371卷 / 22期

关键词：

AORTIC-ROOT DILATION; CLINICAL-TRIAL; DOUBLE-BLIND; BLOCKADE; RECEPTOR; THERAPY; GROWTH; MULTICENTER; PROGRESSION; DILATATION;

D O I：

10.1056/NEJMoa1404731

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Aortic-root dissection is the leading cause of death in Marfan's syndrome. Studies suggest that with regard to slowing aortic-root enlargement, losartan may be more effective than beta-blockers, the current standard therapy in most centers. METHODS We conducted a randomized trial comparing losartan with atenolol in children and young adults with Marfan's syndrome. The primary outcome was the rate of aortic-root enlargement, expressed as the change in the maximum aortic-root-diameter z score indexed to body-surface area (hereafter, aortic-root z score) over a 3-year period. Secondary outcomes included the rate of change in the absolute diameter of the aortic root; the rate of change in aortic regurgitation; the time to aortic dissection, aortic-root surgery, or death; somatic growth; and the incidence of adverse events. RESULTS From January 2007 through February 2011, a total of 21 clinical centers enrolled 608 participants, 6 months to 25 years of age (mean [+/- SD] age, 11.5 +/- 6.5 years in the atenolol group and 11.0 +/- 6.2 years in the losartan group), who had an aorticroot z score greater than 3.0. The baseline-adjusted rate of change (+/- SE) in the aortic-root z score did not differ significantly between the atenolol group and the losartan group (-0.139 +/- 0.013 and -0.107 +/- 0.013 standard-deviation units per year, respectively; P = 0.08). Both slopes were significantly less than zero, indicating a decrease in the degree of aortic-root dilatation relative to body-surface area with either treatment. The 3-year rates of aortic-root surgery, aortic dissection, death, and a composite of these events did not differ significantly between the two treatment groups. CONCLUSIONS Among children and young adults with Marfan's syndrome who were randomly assigned to losartan or atenolol, we found no significant difference in the rate of aorticroot dilatation between the two treatment groups over a 3-year period.

引用

页码：2061 / 2071

页数：11

共 29 条

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