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• comparing propanol vs. placebo
◦
◦
◦
◦
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mortality in 12% vs. 9% (p = 0.36)
elective surgery for AAA in 20% vs. 26% (p = 0.11)
cessation of study medication in 42.4% vs. 26.8% (p = 0.0002)
withdrawal due to adverse effects 38% vs. 21% (NNH 6)
• Reference - J Vasc Surg 2002 Jan;35(1):72 in J Watch 2002 Mar 15;22(6):46
Associated Conditions
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◦ propranolol poorly tolerated and might increase mortality (level 2 [mid-level] evidence)
Treatment Overview
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• based on small randomized trial with high dropout rate
• 54 patients with small AAA diagnosed on screening were randomized
15to propranolol 40 mg vs. placebo
orally twice dailyvs. placebo for mean 2.5 years
• comparing propanol vs. placebo
Follow-up
Prognosis
Prevention and Screening
Quality Improvement
◦ mortality in 16.7% vs. 4.2% (relative risk [RR] = 1.6, 95% CI 1.02-2.51)
◦ dropout rate 60% vs. 25% (RR = 1.74, 95% CI 1.06-2.86)
ACE inhibitors:
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ACE inhibitors reported to be associated with reduced risk of ruptured AAA (level 3 [lacking direct] evidence)
+ ICD-9/ICD-10 Codes
+ References
• based on case-control study
• retrospective study of 15,326 patients > 65 years old admitted to hospital for AAAvs. placebo for mean 2.5 years
• 3,379 (22%) had ruptured AAA and 11,947 (78%) had intact AAA
• ACE inhibitor use reported in 665 (20%) with ruptured AAA vs. 2,761 (23%) with intact AAA
(odds ratio 0.82, 95% CI 0.74-0.9)
• no statistically significant associations found for beta blockers,
calcium channel blockers, alpha blockers,
16
angiotensin receptor blockers, or thiazide diuretics
• Reference - Lancet 2006 Aug 19;368(9536):659
EBSCOhost Full Text editorial can be found in Lancet
2006 Aug 19;368(9536):622 EBSCOhost Full Text Am Fam Physician 2006 Nov 15;74(10):1780
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