Medical management of abdominal anuerysm

Management of abdominal aneurysm (AA) has always been problematic. First of all, they are usually assymptomatic, until they grow so large that there is a complication, eg dissection or rupture. Surgical resection of AA, a good treatemnt, is fraught with dangers as these patients are usually old and often have significant co-morbidities.

A recent large observational data review by Dr Hackam, published in the Aug 19th issue of Lancet, seems to suggest that angiotensin 2 production seem to injure the aortic wall, contributing to AA formation, and the use of ACE-I is associated with a lower rate of AA rupture. This was also supported by 4 or 5 animal studies. It appears that this beneficial ACE-I action is independent of their BP lowering effect. Other hypotensive agents like CCB, betablockers did not seem to prevent AA rupture. I wonder, if ACE-I can block the toxic effects of angiotensin2 on the aprtic wall, will ARBs do the same. For example, will valsartan reduce the incidence of AA rupture? Interesting, at the present, there is no data available to support this, although it makes pathophysiological sense.