THE MEDICAL-TREATMENT OF ABDOMINAL AORTIC -ANEURYSMS WITH BETA-BLOCKERS

There is no known treatment capable of avoiding extention and rupture of aneurysms of the abdominal aorta. There has however been much work recently suggesting a favourable effect of beta-blockers. Early work w ith experimental animal models of aortic aneurysms showed that Propran olol has a protective effect on extention and rupture of these aneurys ms. Studies of the biochemistry of the aortic wall have shown that Pro pranolol has an independent effect on blood pressure, stimulation lysy l-oxidase and production of intermolecular elastin bridges which stren gthen the arterial wall. In man, Propranolol slows the progressive dil atation of the aorta in Marfan's disease. These data on atherosclerous aneurysms are only part of the picture, but 3 studies have shown that slower widening of the aorta diameter is related to treatment with be ta-blockers. In conclusion, the surgical indications for aneurysms in 1995 are unchanged from those in 1994. In cases where surgery is not i ndicated (patient refusal, operative risk too high, small aneurysms) c ould comprise a study group for a randomized evaluation against placeb o of the effect of beta-blockers. A controlled study is required befor e therapeutic strategies can be modified.