{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T22:51:51Z","timestamp":1786229511942,"version":"build-2736575974"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Thoracic aortic dissection (TAD) is a potentially fatal condition. It has been linked with hypertension, and guidelines recommend antihypertensives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Electronic searches were conducted in MEDLINE and EMBASE with the following search strategy: ((\u201cthoracic aortic dissection\u201d[Mesh]) AND (\u201cantihypertensive agents\u201d[Mesh] from database inception to August 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Hypertension is associated with a significant risk of TAD with a hazard ratio (HR) of 2.51 (95% CI: 1.75\u20133.60). Beta-blocker treatment produces a significant (P\u2005&amp;lt;\u20050.01) lower risk of an MACE HR of 0.55 (95% CI\u2005=\u20050.39-0.77). Angiotensin receptor blockers (ARBs) or ACE inhibitors also lower the risk of a major adverse cardiac event with a HR of 0.67 (95% CI\u2005=\u20050.58\u20130.78). Calcium channel blockers (CCB) significantly (P\u2005=0.0007) lowered MACE outcomes with a HR of 0.66 (95% CI\u2005=\u20050.53\u20130.84). A network meta-analysis was performed to evaluate the relative risk of aortic events associated with commonly prescribed antihypertensive agents, using beta-blockers (BB) as the reference comparator. Compared to BB, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACE\/ARB) were associated with a non-significant increase in risk (HR 1.28, 95% confidence interval (CI): 0.91\u20131.81). CCB also demonstrated a non-significant reduction in risk (HR 0.68, 95% CI: 0.33\u20131.40) to BBs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Hypertension is strongly associated with a risk of TAD. Beta-blockers are associated with the greatest reduction in MACE and remain the most effective first-line therapy for patients at risk of TAD. ACE inhibitors and ARBs also demonstrate benefit.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajh\/hpaf132","type":"journal-article","created":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T04:25:32Z","timestamp":1762662332000},"page":"312-322","source":"Crossref","is-referenced-by-count":3,"title":["Hypertension in Thoracic Aortic Dissection: A Meta-Analysis-Based Consideration in the Choice of Antihypertensive Agents"],"prefix":"10.1093","volume":"39","author":[{"given":"Sohat","family":"Sharma","sequence":"first","affiliation":[{"name":"University of British Columbia , Vancouver ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayant","family":"Seth","sequence":"additional","affiliation":[{"name":"University of British Columbia , Vancouver ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon W","family":"Rabkin","sequence":"additional","affiliation":[{"name":"University of British Columbia , Vancouver ,","place":["Canada"]},{"name":"Division of Cardiology, Department of Medicine, University of British Columbia , Vancouver ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,11,4]]},"reference":[{"key":"2026020915220620200_CIT0001","doi-asserted-by":"publisher","first-page":"1271","DOI":"10.1378\/chest.117.5.1271","article-title":"Epidemiology and clinicopathology of aortic dissection","volume":"117","author":"M\u00e9sz\u00e1ros","year":"2000","journal-title":"Chest"},{"key":"2026020915220620200_CIT0002","doi-asserted-by":"publisher","first-page":"e181281","DOI":"10.1001\/jamanetworkopen.2018.1281","article-title":"Association of mortality and acute aortic events with ascending aortic aneurysm: a systematic review and meta-analysis","volume":"1","author":"Guo","year":"2018","journal-title":"JAMA Netw Open"},{"key":"2026020915220620200_CIT0003","doi-asserted-by":"publisher","first-page":"21","DOI":"10.3389\/fcvm.2015.00021","article-title":"Accentuating and opposing factors leading to development of thoracic aortic aneurysms not due to genetic or inherited conditions","volume":"2","author":"Rabkin","year":"2015","journal-title":"Front Cardiovasc Med"},{"key":"2026020915220620200_CIT0004","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1093\/cvr\/cvy006","article-title":"From genetics to response to injury: vascular smooth muscle cells in aneurysms and dissections of the ascending aorta","volume":"114","author":"Michel","year":"2018","journal-title":"Cardiovasc Res"},{"key":"2026020915220620200_CIT0005","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1016\/bs.pmbts.2017.02.002","article-title":"The role matrix metalloproteinases in the production of aortic aneurysm","volume":"147","author":"Rabkin","year":"2017","journal-title":"Prog Mol Biol Transl Sci"},{"key":"2026020915220620200_CIT0006","doi-asserted-by":"publisher","first-page":"e334","DOI":"10.1161\/CIR.0000000000001106","article-title":"2022 ACC\/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association\/American College of Cardiology Joint Committee on Clinical Practice Guidelines","volume":"146","author":"Isselbacher","year":"2022","journal-title":"Circulation"},{"key":"2026020915220620200_CIT0007","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/j.athoracsur.2024.01.021","article-title":"EACTS\/STS guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ","volume":"118","author":"Czerny","year":"2024","journal-title":"Ann Thorac Surg"},{"key":"2026020915220620200_CIT0008","doi-asserted-by":"publisher","first-page":"e127","DOI":"10.1016\/j.jacc.2017.11.006","article-title":"2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults","volume":"71","author":"Whelton","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"2026020915220620200_CIT0009","doi-asserted-by":"publisher","first-page":"e007618","DOI":"10.1161\/JAHA.117.007618","article-title":"Reduced long-term risk of aortic aneurysm and aortic dissection among individuals with type 2 diabetes mellitus: a nationwide observational study","volume":"7","author":"Avdic","year":"2018","journal-title":"J Am Heart Assoc"},{"key":"2026020915220620200_CIT0010","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1161\/CIRCULATIONAHA.121.056546","article-title":"Blood pressure, hypertension, and the risk of aortic dissection incidence and mortality: results from the J-SCH study, the UK biobank study, and a meta-analysis of cohort studies","volume":"145","author":"Hibino","year":"2022","journal-title":"Circulation"},{"key":"2026020915220620200_CIT0011","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1016\/j.athoracsur.2023.03.037","article-title":"Aortic size at the time of type A and type B dissections","volume":"116","author":"Perez","year":"2023","journal-title":"Ann Thorac Surg"},{"key":"2026020915220620200_CIT0012","doi-asserted-by":"publisher","first-page":"W65","DOI":"10.7326\/0003-4819-151-4-200908180-00136","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration","volume":"151","author":"Liberati","year":"2009","journal-title":"Ann Intern Med"},{"key":"2026020915220620200_CIT0013"},{"key":"2026020915220620200_CIT0014"},{"key":"2026020915220620200_CIT0015","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v106.i02","article-title":"Netmeta: An R package for network meta-analysis using frequentist methods","volume":"106","author":"Balduzzi","year":"2023","journal-title":"J. Stat. Soft."},{"key":"2026020915220620200_CIT0016","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying heterogeneity in a meta-analysis","volume":"21","author":"Higgins","year":"2002","journal-title":"Stat Med"},{"key":"2026020915220620200_CIT0017","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1002\/bjs.1800780407","article-title":"Predictors of death from aortic aneurysm among middle-aged men: the whitehall study","volume":"78","author":"Strachan","year":"1991","journal-title":"Br J Surg"},{"key":"2026020915220620200_CIT0018","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1161\/01.cir.85.1.205","article-title":"Are aortic aneurysms caused by atherosclerosis","volume":"85","author":"Reed","year":"1992","journal-title":"Circulation"},{"key":"2026020915220620200_CIT0019","doi-asserted-by":"publisher","first-page":"e001513","DOI":"10.1161\/JAHA.114.001513","article-title":"Risk profiles for aortic dissection and ruptured or surgically treated aneurysms: a prospective cohort study","volume":"4","author":"Landenhed","year":"2015","journal-title":"J Am Heart Assoc"},{"key":"2026020915220620200_CIT0020","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1016\/j.jcma.2015.10.014","article-title":"Sleep apnea and risk of aortic dissection: a nonrandomized, pair-matched cohort study","volume":"79","author":"Teng","year":"2016","journal-title":"J Chin Med Assoc"},{"key":"2026020915220620200_CIT0021","doi-asserted-by":"publisher","first-page":"1248","DOI":"10.1093\/eurheartj\/ehac823","article-title":"Targeting endothelial tight junctions to predict and protect thoracic aortic aneurysm and dissection","volume":"44","author":"Yang","year":"2023","journal-title":"Eur Heart J"},{"key":"2026020915220620200_CIT0022","doi-asserted-by":"publisher","first-page":"e0302669","DOI":"10.1371\/journal.pone.0302669","article-title":"Analysis of outcomes and prognostic factor in acute type A aortic dissection complicated with preoperative shock: a single-center study","volume":"19","author":"Lin","year":"2024","journal-title":"PLoS One"},{"key":"2026020915220620200_CIT0023","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1177\/1457496920910004","article-title":"Overall survival and factors predicting long-term outcome after thoracic aortic endovascular repair","volume":"110","author":"Coster","year":"2021","journal-title":"Scand J Surg"},{"key":"2026020915220620200_CIT0024","doi-asserted-by":"publisher","first-page":"6618","DOI":"10.21037\/jtd-20-2336","article-title":"Impact of hypertension on short- and long-term survival of patients who underwent emergency surgery for type A acute aortic dissection","volume":"12","author":"Wang","year":"2020","journal-title":"J Thorac Dis"},{"key":"2026020915220620200_CIT0025","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1038\/ajh.2009.5","article-title":"Determinants of long-term mortality in patients with type B acute aortic dissection","volume":"22","author":"Sakakura","year":"2009","journal-title":"Am J Hypertens"},{"key":"2026020915220620200_CIT0026","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1016\/j.amjcard.2011.08.012","article-title":"Type-selective benefits of medications in treatment of acute aortic dissection (from the International Registry of Acute Aortic Dissection [IRAD])","volume":"109","author":"Suzuki","year":"2012","journal-title":"Am J Cardiol"},{"key":"2026020915220620200_CIT0027","doi-asserted-by":"publisher","first-page":"e210469","DOI":"10.1001\/jamanetworkopen.2021.0469","article-title":"Association of long-term use of antihypertensive medications with late outcomes among patients with aortic dissection","volume":"4","author":"Chen","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2026020915220620200_CIT0028","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1016\/j.avsg.2021.07.056","article-title":"The effect of intravenous and oral beta-blocker use in patients with type B thoracic aortic dissection","volume":"80","author":"Nejim","year":"2022","journal-title":"Ann Vasc Surg"},{"key":"2026020915220620200_CIT0029","doi-asserted-by":"publisher","first-page":"e002082","DOI":"10.1136\/openhrt-2022-002082","article-title":"Pharmacological treatment in patients with aortic dissection","volume":"9","author":"Smedberg","year":"2022","journal-title":"Open Heart"},{"key":"2026020915220620200_CIT0030","doi-asserted-by":"publisher","first-page":"2628","DOI":"10.1016\/j.mayocp.2021.02.027","article-title":"A population-based study of the incidence and natural history of degenerative thoracic aortic aneurysms","volume":"96","author":"Huang","year":"2021","journal-title":"Mayo Clin Proc"},{"key":"2026020915220620200_CIT0031","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fphar.2023.1291900","article-title":"Prescription pattern and effectiveness of antihypertensive drugs in patients with aortic dissection who underwent surgery","volume":"14","author":"Liao","year":"2023","journal-title":"Front Pharmacol"},{"key":"2026020915220620200_CIT0032","doi-asserted-by":"publisher","first-page":"1511","DOI":"10.1097\/HJH.0000000000003518","article-title":"Proximal aorta dilatation in hypertension","volume":"41","author":"Zuo","year":"2023","journal-title":"J Hypertens"},{"key":"2026020915220620200_CIT0033","doi-asserted-by":"publisher","first-page":"907","DOI":"10.1093\/ajh\/hpt293","article-title":"Increasing prevalence of hypertension among patients with thoracic aorta dissection: trends over eight decades--a structured meta-analysis","volume":"27","author":"Chan","year":"2014","journal-title":"Am J Hypertens"},{"key":"2026020915220620200_CIT0034","doi-asserted-by":"publisher","first-page":"2031","DOI":"10.1161\/CIRCULATIONAHA.112.000483","article-title":"Oxford vascular study population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the oxford vascular study","volume":"127","author":"Howard","year":"2013","journal-title":"Circulation"},{"key":"2026020915220620200_CIT0035","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1093\/bja\/aen173","article-title":"Dihydropiridine calcium-channel blockers and perioperative mortality in aortic aneurysm surgery","volume":"101","author":"Kertai","year":"2008","journal-title":"Br J Anaesth"},{"key":"2026020915220620200_CIT0036","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1016\/S0741-5214(02)00129-5","article-title":"Are antihypertensive drugs associated with abdominal aortic aneurysms","volume":"36","author":"Wilmink","year":"2002","journal-title":"J Vasc Surg"},{"key":"2026020915220620200_CIT0037","doi-asserted-by":"publisher","first-page":"1213","DOI":"10.1161\/CIRCULATIONAHA.105.595496","article-title":"Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) Study","volume":"113","author":"Williams","year":"2006","journal-title":"Circulation"},{"key":"2026020915220620200_CIT0038","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1161\/01.hyp.25.3.327","article-title":"Lisinopril improves aortic compliance and renal flow. comparison with nifedipine","volume":"25","author":"Shimamoto","year":"1995","journal-title":"Hypertension"},{"key":"2026020915220620200_CIT0039","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1161\/ATVBAHA.118.312158","article-title":"Reversal of aortic enlargement induced by increased biomechanical forces requires AT1R inhibition in conjunction With AT2R activation","volume":"39","author":"Zhou","year":"2019","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"2026020915220620200_CIT0040","doi-asserted-by":"publisher","first-page":"2160","DOI":"10.1093\/eurheartj\/ehv151","article-title":"Marfan sartan: a randomized, double-blind, placebo-controlled trial","volume":"36","author":"Milleron","year":"2015","journal-title":"Eur Heart J"},{"key":"2026020915220620200_CIT0041","doi-asserted-by":"publisher","first-page":"e266","DOI":"10.1161\/CIR.0b013e3181d4739e","article-title":"2010 ACCF\/AHA\/AATS\/ACR\/ASA\/SCA\/SCAI\/SIR\/STS\/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American college of cardiology foundation\/American heart association task force on practice guidelines, American association for thoracic surgery, american college of radiology, american stroke association, society of cardiovascular anesthesiologists, society for cardiovascular angiography and interventions, society of interventional radiology, society of thoracic surgeons, and society for vascular medicine","volume":"121","author":"Hiratzka","year":"2010","journal-title":"Circulation"},{"key":"2026020915220620200_CIT0042","doi-asserted-by":"publisher","first-page":"404","DOI":"10.3400\/avd.oa.14-00063","article-title":"Pulse wave velocity involving proximal portions of the aorta correlates with the degree of aortic dilatation at the sinuses of valsalva in ascending thoracic aortic aneurysms","volume":"7","author":"Rabkin","year":"2014","journal-title":"Ann Vasc Dis"},{"key":"2026020915220620200_CIT0043","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1007\/s11517-017-1693-z","article-title":"Hemodynamic assessments of the ascending thoracic aortic aneurysm using fluid-structure interaction approach","volume":"56","author":"Yeh","year":"2018","journal-title":"Med Biol Eng Comput"},{"key":"2026020915220620200_CIT0044","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1016\/s0741-5214(03)00136-8","article-title":"Smokers\u2019 relative risk for aortic aneurysm compared with other smoking-related diseases: a systematic review","volume":"38","author":"Lederle","year":"2003","journal-title":"J Vasc Surg"},{"key":"2026020915220620200_CIT0045","doi-asserted-by":"publisher","first-page":"1702","DOI":"10.1093\/cvr\/cvy174","article-title":"Diabetes and aortic aneurysm: current state of the art","volume":"114","author":"Raffort","year":"2018","journal-title":"Cardiovasc Res"}],"container-title":["American Journal of Hypertension"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajh\/advance-article-pdf\/doi\/10.1093\/ajh\/hpaf132\/65231965\/hpaf132.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajh\/article-pdf\/39\/2\/312\/65231965\/hpaf132.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajh\/article-pdf\/39\/2\/312\/65231965\/hpaf132.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T20:22:13Z","timestamp":1770668533000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajh\/article\/39\/2\/312\/8315337"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,4]]},"references-count":45,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,11,4]]},"published-print":{"date-parts":[[2026,2,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ajh\/hpaf132","relation":{},"ISSN":["0895-7061","1941-7225"],"issn-type":[{"value":"0895-7061","type":"print"},{"value":"1941-7225","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,2]]},"published":{"date-parts":[[2025,11,4]]}}}