In this long-term CT-based cohort of patients with nonsyndromic aTAA, beta blocker therapy was not independently associated with slower ascending aortic growth or changes in indexed aortic dimensions.
Key Findings
Results
Baseline ascending aortic diameter was comparable between beta blocker users and nonusers.
390 adults with nonsyndromic ascending thoracic aortic aneurysms (aTAA) were included in this retrospective single-center cohort study.
311 patients were beta blocker users and 79 were nonusers.
Baseline ascending aortic diameter was 45.1 ± 3.5 mm in users vs. 45.2 ± 3.6 mm in nonusers (P = 0.73).
All patients underwent at least two contrast-enhanced CT examinations separated by a minimum of 2 years.
Results
Annual ascending aortic growth rates were similar between beta blocker users and nonusers over a mean follow-up of over 6 years.
Mean CT follow-up duration was 73.2 ± 39.1 months.
Annual ascending aortic growth rates were 0.40 ± 0.54 mm/year in beta blocker users vs. 0.45 ± 0.65 mm/year in nonusers (P = 0.49).
Changes in ascending aortic size index (ASI) and ascending aortic height index (AHI) also did not differ according to beta blocker therapy.
The primary outcome was the annual ascending aortic growth rate measured by serial CT.
Results
Beta blocker use was not independently associated with annual ascending aortic growth in multivariable linear regression analysis.
Standardized β = -0.031, P = 0.548 for beta blocker use as a predictor of annual ascending aortic growth.
Univariate and multivariable linear regression analyses were performed to identify independent predictors of annual aortic growth.
Secondary outcomes of changes in ASI and AHI were also not independently associated with beta blocker use.
Results
Exploratory subgroup analyses showed numerically lower annual growth rates among beta blocker users with larger baseline aortic diameters or bicuspid aortic valves, but neither reached statistical significance.
Numerically lower annual growth rates were observed in beta blocker users with baseline ascending aortic diameters ≥48 mm.
Numerically lower annual growth rates were also observed in beta blocker users with bicuspid aortic valves.
These were described as exploratory subgroup analyses.
Conclusions
The study authors concluded that larger prospective studies are needed to clarify the role of beta blockers in limiting aneurysm progression.
The study was retrospective and conducted at a single center, which limits generalizability.
Patient classification was based on beta blocker therapy use (users vs. nonusers).
The study included only nonsyndromic aTAA patients, excluding syndromic conditions such as Marfan syndrome.
The authors noted the uncertainty regarding the role of beta blockers in slowing aneurysm progression in this patient population.
What This Means
This research examined whether beta-blocker medications (a common type of heart drug) slow the growth of enlarged aortas — the main blood vessel leaving the heart — in patients without a genetic syndrome. Researchers followed 390 patients over an average of about 6 years using repeated CT scans, comparing 311 patients who took beta-blockers to 79 who did not. The study found that the aorta grew at nearly the same rate in both groups (about 0.40 mm per year in beta-blocker users vs. 0.45 mm per year in nonusers), and this difference was not statistically meaningful.
The study also looked at whether beta-blockers affected other measures of aortic size relative to body size, and again found no significant difference between the two groups. When the researchers used statistical modeling to account for other factors that might influence aortic growth, beta-blocker use still did not emerge as a meaningful predictor of slower aortic growth. A closer look at specific patient subgroups — those with larger aneurysms or a bicuspid (two-leaflet) aortic valve — hinted at potentially lower growth rates among beta-blocker users, but these differences were too small and inconsistent to be considered reliable findings.
This research suggests that beta-blocker therapy, as commonly used in real-world clinical practice, may not meaningfully slow the enlargement of the aorta in patients with non-genetic aortic aneurysms. This is an important finding because beta-blockers are sometimes prescribed with the expectation of limiting aneurysm growth, yet this long-term CT-based analysis did not support that benefit. The authors note that larger, carefully designed prospective studies are needed before firm conclusions can be drawn about whether beta-blockers play any protective role in this patient population.
İşletme A, Deveci S, Eren S, Hatipoğlu E, Gümüşdağ A, Karataş M, et al.. (2026). Beta-blocker therapy and aortic growth in nonsyndromic ascending thoracic aortic aneurysms: a serial CT analysis.. Journal of cardiovascular medicine (Hagerstown, Md.). https://doi.org/10.2459/JCM.0000000000001947