HEART: Pilot Randomized Controlled Trial

Inclusion criteria

• Adults ≥ 18 years old with dTAA of the aortic root and/or ascending aorta exceeding the upper limit of normal for age, sex, and body surface area (≥ 4.0 cm as an example of a common threshold; but age, sex and body size-specific thresholds have been established for the aortic root24 and ascending aorta25);
• no antihypertensive use or stable antihypertensive regimen ≥ 4 weeks;
• eGFR ≥ 50 mL/min/1.73 m²;
• serum potassium ≤ 5.1 mmol/L;
• ability to provide informed consent.

Exclusion criteria

• Heritable aortopathies (Marfan, Loeys-Dietz, vascular Ehlers-Danlos, Turner syndromes; familial TAA, genetically-proven TAA);
• bicuspid aortic valve;
• inflammatory aortitis,
• prior aortic surgery, endovascular repair, or acute aortic syndrome;
• permanent atrial fibrillation/flutter;
• major peripheral artery disease affecting the carotids, iliacs and/or external femoral arteries precluding cfPWV measurement;
• current use of spironolactone, eplerenone or finererone;
• pregnancy or lactation.