Usefulness of Enalapril Versus Propranolol or Atenolol for Prevention of Aortic Dilation in Patients With the Marfan Syndrome

Despite variable clinical results, β blockers have become the primary therapy for prevention of aortic dilation in patients with the Marfan syndrome. This study examines the use of the angiotensin-converting enzyme inhibitor enalapril for treatment of these patients. We sought to examine the effects of enalapril versus β-blocker therapy in patients with the Marfan syndrome and noted improved aortic distensibility (3.0 ± 0.3 vs 1.9 ± 0.4 cm2 dynes−1; p <0.02) and a reduced aortic stiffness index (8.0 ± 2.9 vs 18.4 ± 3.8; p <0.05) in patients receiving enalapril compared with those receiving β blockers. These favorable hemodynamic changes were associated with a smaller increase in aortic root diameter (0.1 ± 1.0 vs 5.8 ± 5.2 mm) and fewer clinical end points during follow-up.