Renin‐Angiotensin‐Aldosterone System Inhibitors Are Associated With Favorable Outcomes Compared to Beta Blockers in Reducing Mortality Following Abdominal Aneurysm Repair

BACKGROUND: The best medical therapy to control hypertension following abdominal aortic aneurysm repair is yet to be determined. We therefore examined whether treatment with renin‐angiotensin‐aldosterone system inhibitors (RAASIs) versus beta blockers influenced postoperative and 1‐year clinical end points following abdominal aortic aneurysm repair in a Medicare‐linked database. METHODS AND RESULTS: All patients with hypertension undergoing endovascular aneurysm repair and open aneurysm repair in the Vascular Quality Initiative Vascular Implant Surveillance and Interventional Outcomes Network database between 2003 and 2018 were included. Patients were divided into 2 groups based on their preoperative and discharge medications, either RAASIs or beta blockers. Our cohort included 8789 patients, of whom 3523 (40.1%) were on RAASIs, and 5266 (59.9%) were on beta blockers. After propensity score matching, there were 3053 matched pairs of patients in each group. After matching, RAASI use was associated with lower risk of postoperative mortality (odds ratio [OR], 0.3 [95% CI, 0.1–0.6]), myocardial infarction (OR, 0.1 [95% CI, 0.03–0.6]), and nonhome discharge (OR, 0.6 [95% CI, 0.5–0.7]). Before propensity score matching, RAASI use was associated with lower 1‐year mortality (hazard ratio [HR], 0.4 [95% CI, 0.4–0.5]) and lower risk of aneurysmal rupture (HR, 0.7 [95% CI, 0.5–0.9]). These results persisted after propensity score matching for mortality (HR, 0.4 [95% CI, 0.4–0.5]) and aneurysmal rupture (HR, 0.7 [95% CI, 0.5–0.9]). CONCLUSIONS: In this large contemporary retrospective cohort study, RAASI use was associated with favorable postoperative outcomes compared with beta blockers. It was also associated with lower mortality and aneurysmal rupture at 1 year of follow‐up.