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Since 2003, bioavailability regulations of TGF-\u00df through fibrillin alterations have been presumed of being the culprit mechanisms for aortic aneurysm development. We present the analysis of our single-center Marfan children and adolescents cohort to assess the influence of age, sex, degree of cardiovascular involvement and dosage on losartan effectivity. This prospective longitudinal registered echocardiographical investigation (EudraCT 2009-016139-36) of 49 patients with an average follow-up of 72\u00a0months focused on aortic root <jats:italic>z<\/jats:italic>-scores, elasticity, and yearly progression rates. The 33 patients under medication with losartan showed an aortic root <jats:italic>z<\/jats:italic>-score reduction during the first 36\u00a0months compared to 22 patients without medication presenting constant mild progression. Yet, results diminished under losartan thereafter, adding up to similar progressions over 72\u00a0months in both groups (0.07\u2009\u00b1\u20090.10\/year versus 0.04\u2009\u00b1\u20090.11\/year). Although male patients exhibited higher root <jats:italic>z<\/jats:italic>-scores, progression with and without medication was comparable to females and not age-dependent. In conclusion, losartan evoked a significant aortic root <jats:italic>z<\/jats:italic>-score regression in young Marfan patients over the first 3\u00a0years, but this effect mitigated thereafter. The initial improvement concurred with ameliorated elasticity; lower stiffness levels predicted better clinical outcome, but likewise only up to 36\u00a0months. Sex differences in dilatation severity were observed but neither age nor sex had significant influence on progression rates. Losartan dosages were gradually increased in more severely affected patients and provided an equal rate of root progression over 72\u00a0months in comparison to patients under losartan treatment with lesser baseline dilatation severity.<\/jats:p>","DOI":"10.1007\/s00246-021-02761-4","type":"journal-article","created":{"date-parts":[[2021,11,10]],"date-time":"2021-11-10T13:02:39Z","timestamp":1636549359000},"page":"586-595","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Initial Angiotensin Receptor Blocker Response in Young Marfan Patients Decreases After 3 Years of Treatment"],"prefix":"10.1007","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8624-1195","authenticated-orcid":false,"given":"Christiane","family":"Pees","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julian","family":"Heno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ina","family":"Michel-Behnke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,11,10]]},"reference":[{"key":"2761_CR1","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1038\/352337a0","volume":"352","author":"HC Dietz","year":"1991","unstructured":"Dietz HC, Cutting GR, Pyeritz RE, Maslen CL, Sakai LY, Corson GM, Puffenberger EG, Hamosh A, Nanthakumar EJ, Curristin SM, Stetten G, Meyers DA, Francomano CA (1991) Marfan syndrome caused by recurrent de novo missense mutation in the fibrillin gene. 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