Atenolol versus Losartan in Marfan's Syndrome

To the Editor: Lacro et al. (Nov. 27 issue) 1 report no benefit of losartan, an angiotensin-receptor blocker (ARB), over the beta-blocker atenolol in respect to the rate of aortic-root dilatation in Marfan's syndrome. A possible interpretation of this study might be that ARBs are as effective as beta-blockers in the treatment of patients with Marfan's syndrome. 2 However, such an interpretation assumes that beta-blockers are an effective treatment option. Beta-blockers are presently considered to be first-line therapy in patients with Marfan's syndrome. However, their benefit is debatable and not supported by robust evidence. Several observational studies and only one clinical trial . . .