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dc.contributor.authorMullen, Michael
dc.contributor.authorJin, Xu Yu
dc.contributor.authorChild, Anne
dc.contributor.authorStuart, A Graham
dc.contributor.authorDodd, Matthew
dc.contributor.authorAragon-Martin, José Antonio
dc.contributor.authorGaze, David
dc.contributor.authorKiotsekoglou, Anatoli
dc.contributor.authorYuan, Li
dc.contributor.authorHu, Jiangting
dc.contributor.authorFoley, Claire
dc.contributor.authorVan Dyck, Laura
dc.contributor.authorKnight, Rosemary
dc.contributor.authorClayton, Tim
dc.contributor.authorSwan, Lorna
dc.contributor.authorThomson, John D R
dc.contributor.authorErdem, Guliz
dc.contributor.authorCrossman, David
dc.contributor.authorFlather, Marcus
dc.contributor.authorAIMS Investigators
dc.identifier.citationMullen , M , Jin , X Y , Child , A , Stuart , A G , Dodd , M , Aragon-Martin , J A , Gaze , D , Kiotsekoglou , A , Yuan , L , Hu , J , Foley , C , Van Dyck , L , Knight , R , Clayton , T , Swan , L , Thomson , J D R , Erdem , G , Crossman , D , Flather , M & AIMS Investigators 2019 , ' Irbesartan in Marfan syndrome (AIMS) : a double-blind, placebo-controlled randomised trial ' , Lancet , vol. 394 , no. 10216 , pp. 2263-2270 .
dc.identifier.otherPURE: 264469584
dc.identifier.otherPURE UUID: 7f0f0f55-572d-4fca-8a5c-d8be8b4f4311
dc.identifier.otherPubMed: 31836196
dc.identifier.otherORCID: /0000-0003-4762-8623/work/66398427
dc.identifier.otherScopus: 85076749501
dc.identifier.otherWOS: 000503788300029
dc.descriptionFunding: British Heart Foundation, the UK Marfan Trust, the UK Marfan Association.en
dc.description.abstractBACKGROUND: Irbesartan, a long acting selective angiotensin-1 receptor inhibitor, in Marfan syndrome might reduce aortic dilatation, which is associated with dissection and rupture. We aimed to determine the effects of irbesartan on the rate of aortic dilatation in children and adults with Marfan syndrome. METHODS: We did a placebo-controlled, double-blind randomised trial at 22 centres in the UK. Individuals aged 6-40 years with clinically confirmed Marfan syndrome were eligible for inclusion. Study participants were all given 75 mg open label irbesartan once daily, then randomly assigned to 150 mg of irbesartan (increased to 300 mg as tolerated) or matching placebo. Aortic diameter was measured by echocardiography at baseline and then annually. All images were analysed by a core laboratory blinded to treatment allocation. The primary endpoint was the rate of aortic root dilatation. This trial is registered with ISRCTN, number ISRCTN90011794. FINDINGS: Between March 14, 2012, and May 1, 2015, 192 participants were recruited and randomly assigned to irbesartan (n=104) or placebo (n=88), and all were followed for up to 5 years. Median age at recruitment was 18 years (IQR 12-28), 99 (52%) were female, mean blood pressure was 110/65 mm Hg (SDs 16 and 12), and 108 (56%) were taking β blockers. Mean baseline aortic root diameter was 34·4 mm in the irbesartan group (SD 5·8) and placebo group (5·5). The mean rate of aortic root dilatation was 0·53 mm per year (95% CI 0·39 to 0·67) in the irbesartan group compared with 0·74 mm per year (0·60 to 0·89) in the placebo group, with a difference in means of -0·22 mm per year (-0·41 to -0·02, p=0·030). The rate of change in aortic Z score was also reduced by irbesartan (difference in means -0·10 per year, 95% CI -0·19 to -0·01, p=0·035). Irbesartan was well tolerated with no observed differences in rates of serious adverse events. INTERPRETATION: Irbesartan is associated with a reduction in the rate of aortic dilatation in children and young adults with Marfan syndrome and could reduce the incidence of aortic complications.
dc.rightsCopyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.en
dc.subjectRC Internal medicineen
dc.titleIrbesartan in Marfan syndrome (AIMS) : a double-blind, placebo-controlled randomised trialen
dc.typeJournal articleen
dc.description.versionPublisher PDFen
dc.contributor.institutionUniversity of St Andrews.School of Medicineen
dc.contributor.institutionUniversity of St Andrews.Sir James Mackenzie Institute for Early Diagnosisen
dc.contributor.institutionUniversity of St Andrews.Office of the Principalen
dc.description.statusPeer revieweden

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