The medical treatment of abdominal aortic aneurysms with beta-blockers.

There is no known treatment capable of avoiding extention and rupture of aneurysms of the abdominal aorta. There has however been much work recently suggesting a favourable effect of beta-blockers. Early work with experimental animal models of aortic aneurysms showed that Propranolol has a protective effect on extention and rupture of these aneurysms. Studies of the biochemistry of the aortic wall have shown that Propranolol has an independent effect on blood pressure, stimulation lysyl-oxidase and production of intermolecular elastin bridges which strengthen the arterial wall. In man, Propranolol slows the progressive dilatation of the aorta in Marfan's disease. These data on atherosclerous aneurysms are only part of the picture, but 3 studies have shown that slower widening of the aorta diameter is related to treatment with beta-blockers. In conclusion, the surgical indications for aneurysms in 1995 are unchanged from those in 1994. In cases where surgery is not indicated (patient refusal, operative risk too high, small aneurysms) could comprise a study group for a randomized evaluation against placebo of the effect of beta-blockers. A controlled study is required before therapeutic strategies can be modified.