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An evaluation of the effect of an angiotensinconverting enzyme inhibitor on the growth rate of small abdominal aortic aneurysms: A randomized placebo-controlled trial (AARDVARK)

Lookup NU author(s): Timothy Lees, Lesley Wilson


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© The Author 2016.Aims: The AARDVARK (Aortic Aneurysmal Regression of Dilation: Value of ACE-Inhibition on RisK) trial investigated whether ACE-inhibition reduces small abdominal aortic aneurysms (AAA) growth rate, independent of blood pressure (BP) lowering. Methods and results: A three-arm, multi-centre, single-blind, and randomized controlled trial (ISRCTN51383267) was conducted in 14 hospitals in England. Subjects aged ≥55 years with AAA diameter 3.0-5.4 cm were randomized 1:1:1 to receive perindopril arginine 10 mg, or amlodipine 5 mg, or placebo and followed 3-6 monthly over 2 years. The primary outcome was aneurysm growth rate (based on external antero-posterior ultrasound measurements in the longitudinal plane), determined by multi-level modelling to provide maximum likelihood estimates. Two hundred and twenty-four subjects were randomized (2011-2013) to placebo (n = 79), perindopril (n = 73), or amlodipine (n = 72). Mean (SD) changes in mid-trial systolic BP (12 months) were 0.5 (14.3) mmHg, P = 0.78 compared with baseline, 29.5 (13.1) mmHg (P < 0.001), and 26.7 (12.0) mmHg (P < 0.001), respectively. No significant differences in the modelled annual growth rates were apparent [1.68 mm (SE 0.2), 1.77 mm (0.2), and 1.81 mm (0.2), respectively]. The estimated difference in annual growth between the perindopril and placebo groups was 0.08 mm (CI 20.50, 0.65). Similar numbers of AAAs in each group reached 5.5 cm diameter and/or underwent elective surgery: 11 receiving placebo, 10 perindopril, and 11 amlodipine. Conclusion: Small AAA growth rates were lower than anticipated, but there was no significant impact of perindopril compared with placebo or placebo and amlodipine, combined despite more effective BP lowering.

Publication metadata

Author(s): Bicknell CD, Kiru G, Falaschetti E, Powell JT, Poulter NR, Ashby D, Brown L, Dhanjil S, Davies M, Earnshaw J, Shearman C, Newton B, Thompson S, Beevers G, Wilmink T, Allen L, Scriven J, Rolls A, Coghlan C, James R, Whitehouse A, Williams A, Modarai B, Waltham M, Clark S, Davis M, Imray C, Kite A, Chetter I, Clarke E, Firth A, Rittoo D, Baker S, Choksy S, Morgan M, Townsend T, Lees T, Wilson L, Wealleans V, Parr N, Brown A, Mowatt F, Chipp R, Thompson A, Gibson A, Coleman Z, Smith T, Meyer F, Burrows M, Smyth V, Schirro A, Edlin H, Nawaz S, Warren R, King C, Swift D, Okhuoya F, Bailey C

Publication type: Article

Publication status: Published

Journal: European Heart Journal

Year: 2016

Volume: 37

Issue: 42

Pages: 3213-3221

Print publication date: 07/11/2016

Online publication date: 01/07/2016

Acceptance date: 31/05/2016

ISSN (print): 0195-668X

ISSN (electronic): 1522-9645

Publisher: Oxford University Press


DOI: 10.1093/eurheartj/ehw257


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