From the Guidelines
The blood pressure target for a chronic aortic aneurysm should be below 130/80 mmHg, with some patients potentially benefiting from even lower targets of 120/80 mmHg, as recommended by the most recent guidelines 1. To achieve this target, blood pressure control is typically achieved using beta-blockers as first-line agents, such as metoprolol (25-200 mg twice daily), atenolol (25-100 mg daily), or propranolol (40-160 mg twice daily) 1. If beta-blockers alone are insufficient, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) can be added to the regimen 1. For patients who cannot tolerate beta-blockers, calcium channel blockers like amlodipine (5-10 mg daily) may be used 1. Regular blood pressure monitoring is essential, with home measurements recommended twice daily. The goal of strict blood pressure control is to reduce the hemodynamic stress on the aortic wall, which helps minimize the risk of aneurysm expansion and rupture. Beta-blockers specifically reduce the force of cardiac contraction and heart rate, decreasing the pulsatile force against the weakened aortic wall. Lifestyle modifications including sodium restriction, regular exercise, weight management, and smoking cessation should accompany pharmacological therapy for optimal aneurysm management 1. Some key points to consider in the management of chronic aortic aneurysm include:
- Screening for abdominal aortic aneurysm is recommended in men aged ≥65 years and with a history of smoking to reduce the risk of death from ruptured AAA 1
- A healthy diet rich in legumes, dietary fibre, nuts, fruits, and vegetables, with a high flavonoid intake (Mediterranean diet), is recommended for CV disease prevention in patients with PAAD 1
- Low- to moderate-intensity (or high if tolerated) aerobic activities are recommended in patients with PAD to increase overall and pain-free walking distance 1
- In patients with PAAD, cessation and abstinence from smoking of any kind is recommended to reduce the risk of AD, MI, death, and limb ischaemia 1
From the Research
Blood Pressure Target for Chronic Aortic Aneurysm
- The ideal blood pressure target for a chronic aortic aneurysm is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, study 2 mentions that the controlled (permissive) hypotension resuscitation strategy has a target systolic blood pressure of 50 mmHg to 100 mmHg for people with ruptured abdominal aortic aneurysm.
- Study 6 found that hypertension increases the risk of developing abdominal aortic aneurysms (AAA) by 66%, and that there is a 14% and 28% increase in the risk of AAA for every 20 mmHg and 10 mmHg increase in systolic blood pressure (SBP) and diastolic blood pressure (DBP), respectively 6.
- It is essential to note that these studies do not provide a specific blood pressure target for chronic aortic aneurysm, but rather discuss the relationship between blood pressure and the risk of aneurysm development or rupture 4, 5, 6.
Management of Blood Pressure in Aortic Aneurysm
- Studies suggest that certain medications, such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), may be associated with a reduced risk of ruptured abdominal aortic aneurysm 4, 5.
- Beta-blockers, on the other hand, do not appear to significantly influence aortic aneurysm growth 3.
- The management of blood pressure in patients with aortic aneurysm should be individualized and based on the specific characteristics of the patient and the aneurysm 2, 4, 5, 6.