From the Guidelines
The target blood pressure for patients with abdominal aortic aneurysm should be towards 120–129 mmHg, if tolerated, to reduce the risk of rupture and improve outcomes. This recommendation is based on the latest guidelines from the European Heart Journal, which emphasize the importance of blood pressure control in managing peripheral arterial and aortic diseases, including abdominal aortic aneurysm (AAA) 1.
Key Considerations
- Blood pressure control is crucial in AAA management as hypertension increases wall stress on the aneurysm, potentially accelerating expansion and increasing rupture risk.
- The recommended systolic blood pressure (SBP) target of 120–129 mmHg is applicable to patients with PAAD and hypertension, including those with AAA 1.
- Antihypertensive therapy should be individualized, considering the patient's overall cardiovascular risk profile and tolerance to medication.
- Lifestyle modifications, including a healthy diet, regular physical activity, smoking cessation, and weight management, are essential adjuncts to medication therapy.
Management Approach
- First-line antihypertensive medications may include ACE inhibitors or ARBs, which help manage blood pressure while potentially offering additional benefits in vascular remodeling.
- Regular monitoring of blood pressure at home is recommended, with readings taken at consistent times and positions to ensure adequate control.
- Patients with larger aneurysms or rapidly expanding ones may require more aggressive blood pressure control and closer monitoring.
Evidence-Based Recommendations
- The 2024 ESC guidelines for the management of peripheral arterial and aortic diseases provide a comprehensive approach to managing PAAD, including recommendations for blood pressure control, lifestyle modifications, and antihypertensive therapy 1.
- These guidelines emphasize the importance of individualized care, considering the patient's unique risk factors, comorbidities, and tolerance to medication.
From the Research
Target Blood Pressure for Patients with Abdominal Aortic Aneurysm
The target blood pressure for patients with abdominal aortic aneurysm (AAA) is not explicitly stated in the provided studies. However, the studies suggest that:
- Controlling hypertension is important for patients with AAA, as high blood pressure can increase the risk of aneurysm rupture 2.
- The use of renin-angiotensin-aldosterone system inhibitors (RAASIs) has been associated with favorable outcomes, including lower risk of postoperative mortality and aneurysmal rupture, compared to beta blockers 3.
- Central aortic blood pressure (CABP) is a significant factor in AAA progression, with higher CABP values observed in fast progressors compared to slow progressors 2.
- Patient-specific blood pressure monitoring data can be used to estimate the annual risk of rupture (EARR) of AAA, taking into account factors such as peak wall stress, wall thickness, and wall strength 4.
Key Findings
- The use of RAASIs is associated with lower risk of postoperative mortality and aneurysmal rupture compared to beta blockers 3.
- CABP is a significant factor in AAA progression, with higher values observed in fast progressors 2.
- Patient-specific blood pressure monitoring data can be used to estimate EARR, with consideration of past survival and blood pressure variability improving predictions of future risk 4.
- ACE inhibitors have been associated with a reduced risk of ruptured abdominal aortic aneurysm, unlike other antihypertensive agents 5.
Blood Pressure Management
- Controlling hypertension is crucial for patients with AAA, but the optimal target blood pressure is not explicitly stated in the provided studies.
- The use of RAASIs and ACE inhibitors may be beneficial in reducing the risk of aneurysm rupture and improving outcomes for patients with AAA 3, 5.
- Patient-specific blood pressure monitoring and estimation of EARR can help guide blood pressure management and inform treatment decisions 4.