替米沙坦对小型腹主动脉瘤峰值壁应力和峰值壁破裂指数的影响：TEDY 试验的探索性分析。
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.
机构信息
Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia; Department of Vascular and Endovascular Surgery, The Townsville University Hospital, Townsville, Australia.
Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia; The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia.
出版信息
Eur J Vasc Endovasc Surg. 2022 Oct;64(4):396-404. doi: 10.1016/j.ejvs.2022.07.042. Epub 2022 Aug 6.
OBJECTIVE
This study was an unplanned exploratory analysis of a subset of participants from the Telmisartan in the Management of Abdominal Aortic Aneurysm (TEDY) trial. It 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.
METHODS
Participants with AAAs measuring 35 - 49 mm in maximum diameter were randomised to receive telmisartan 40 mg 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 or placebo using linear mixed effects models. These models were either unadjusted or adjusted for risk factors that were different in the groups at entry (p < .100) or systolic blood pressure (SBP) at one year.
RESULTS
Of the 207 participants recruited to TEDY, 124 were eligible for inclusion in this study. This study included 65 and 59 participants from the telmisartan and placebo groups, respectively. The 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% CI -8.24, -0.14 kPa/year; p = .043) and PWRI (-0.014; 95% CI -0.026, -0.001; p = .032) compared with those allocated placebo after adjusting for risk factors. After adjustment for SBP at one year, telmisartan did not significantly reduce annual increases in PWS or PWRI.
CONCLUSION
The findings of this study suggest that telmisartan limits the rate of increase in PWS and PWRI of small AAAs by reducing blood pressure.
目的
本研究是对 Telmisartan 在腹主动脉瘤管理（TEDY）试验中部分参与者的一项计划外探索性分析。旨在评估血管紧张素 1 受体阻滞剂替米沙坦在降低小 AAA 患者腹主动脉瘤（AAA）峰值壁应力（PWS）和峰值壁破裂指数（PWRI）方面的疗效。
方法
在 TEDY 试验中，最大直径为 35-49mm 的 AAA 患者被随机分配接受替米沙坦 40mg 或安慰剂治疗。在试验期间至少进行了一次计算机断层血管造影（CTA）检查的参与者（12 或 24 个月）被纳入本研究。使用经过验证的方法测量正交 AAA 直径、PWS 和 PWRI。使用线性混合效应模型比较替米沙坦组和安慰剂组参与者从基线开始的 PWS 和 PWRI 的年变化。这些模型未调整或调整了在基线时组间不同的危险因素（p<0.100）或一年时的收缩压（SBP）。
结果
在 TEDY 中招募的 207 名参与者中，有 124 名符合纳入本研究的条件。本研究纳入了替米沙坦组和安慰剂组的 65 名和 59 名参与者。两组在基线时的 PWS 和 PWRI 没有显著差异。与安慰剂组相比，替米沙坦组的 PWS（-4.19；95%CI-8.24，-0.14kPa/年；p=0.043）和 PWRI（-0.014；95%CI-0.026，-0.001；p=0.032）的年增长率较慢。调整危险因素后，替米沙坦组 PWS 和 PWRI 的年增长率较安慰剂组无显著降低。调整一年时的 SBP 后，替米沙坦对 PWS 和 PWRI 的年增长率无显著降低作用。
结论
本研究结果表明，替米沙坦通过降低血压来限制小 AAA 的 PWS 和 PWRI 的增长率。
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