What is the evidence for blood pressure (BP) control in the case of a visceral artery aneurysm?

From the Guidelines

Blood pressure control is crucial for patients with visceral aneurysms, and the goal should be to maintain blood pressure below 130/80 mmHg, as recommended by the 2022 ACC/AHA guideline for the diagnosis and management of aortic disease 1. The primary objective of blood pressure management in patients with visceral aneurysms is to reduce the risk of rupture and subsequent morbidity and mortality.

• Key considerations for blood pressure control include:
  • The use of antihypertensive medication in patients with an average systolic blood pressure (SBP) of ≥130 mm Hg or an average diastolic blood pressure (DBP) of ≥80 mm Hg, as stated in the guideline 1.
  • Achieving an SBP goal of <130 mm Hg and a DBP goal of <80 mm Hg to reduce adverse clinical outcomes, with some patients potentially benefiting from more intensive lowering with an SBP goal of <120 mm Hg 1.
• First-line medications for blood pressure control in patients with visceral aneurysms may include:
  • Beta blockers, which reduce both blood pressure and shear stress on vessel walls, as supported by the guideline 1.
  • Agents that alter the renin-angiotensin system, such as ACE inhibitors or ARBs, which have been shown to be effective in reducing cardiovascular events 1.
• Lifestyle modifications should accompany pharmacotherapy, including:
  • Sodium restriction (<2.3g/day)
  • Regular exercise
  • Weight management
  • Limited alcohol consumption
  • Smoking cessation The rationale for strict blood pressure control is based on the principle that hypertension increases wall tension in aneurysms, according to Laplace's law, where wall tension equals pressure multiplied by radius, and controlling blood pressure reduces this tension, potentially slowing aneurysm growth and decreasing rupture risk 1.

From the Research

Blood Pressure Control in Visceral Aneurysm

• Blood pressure control is crucial in the management of visceral aneurysms, as uncontrolled hypertension can increase the risk of rupture 2, 3
• However, there is limited evidence on the specific blood pressure targets for patients with visceral aneurysms 4, 5
• The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms provide evidence-based size thresholds for repair of aneurysms of the visceral arteries, but do not specifically address blood pressure control 6

Treatment Options for Visceral Aneurysms

• Treatment options for visceral aneurysms include open surgery, endovascular therapy, and a hybrid approach 2, 4
• Endovascular treatment is a minimally invasive technique that can be used to exclude the aneurysm from the circulation, and has been shown to be effective in treating visceral artery aneurysms and pseudoaneurysms 5, 3
• The choice of treatment depends on the anatomical location of the aneurysm, the clinical presentation of the patient, and the presence of any comorbidities 2, 6

Management of Visceral Aneurysms

• Early detection and treatment of visceral aneurysms is essential to prevent rupture and improve outcomes 3
• A comprehensive diagnostic workup, including imaging studies, is necessary to diagnose and plan treatment for visceral aneurysms 2, 5
• The management of visceral aneurysms requires a multidisciplinary approach, involving vascular surgeons, radiologists, and other specialists 6