Use of RAAS inhibitors reduced risk of aneurysm rupture by 18%, study finds

A multicenter study of more than 3,000 people with high blood pressure and brain aneurysms found that using RAAS inhibitors, a class of antihypertensive drugs, reduced the risk of aneurysm rupture by 18%, according to a new study published today. in Hypertension, a peer-reviewed journal of the American Heart Association.

An aneurysm is a bulge or weakening in the wall of an artery. When this occurs in an artery of the brain, it is called an intracranial aneurysm. If an intracranial aneurysm ruptures, it spills blood around the brain and cuts off oxygen to an affected area, which can cause hemorrhagic stroke, coma, and death.

These strokes represent 3-5% of all strokes, but a greater proportion of morbidity and mortality than other types of stroke. Every year, about 30,000 adults in the United States have intracranial aneurysms that rupture, according to the National Institute of Neurological Disorders and Stroke. Additionally, stroke is a leading cause of disability in the United States.

The body is renin-angiotensin-aldosterone system (RAAS) includes hormones that affect blood pressure regulation, and dysregulation of RAAS can lead to the development of high blood pressure. Two components of RAAS have been shown to be involved in the development of intracranial aneurysms, and previous research has shown that dysregulation of RAAS may also contribute to aneurysm rupture. RAAS inhibitors, drugs that block the effects of the RAAS, are often used to treat high blood pressure.

About half of patients with intracranial aneurysms have high blood pressure, which can cause vascular inflammation and increase the risk of aneurysm rupture. Since one third of patients with ruptured aneurysms die and another third remain dependent for activities of daily living, it is necessary to identify modifiable risk factors to prevent aneurysm rupture..”

Qinghai Huang, MD, PhD, lead study author and professor of neurosurgery at Changhai Hospital, Second Military Medical University

This multicenter study analyzed data collected from 2016 to 2021 at 20 medical centers in different regions of China, collected before and after rupture, to assess the association between the use of RAAS inhibitors and other anti-inflammatory drugs. hypertension, including beta-blockers. and diuretics, on the risk of aneurysm rupture.

Over 3,000 adults with high blood pressure and intracranial aneurysms were included. The study sample was made up of one-third men and two-thirds women, with an average age of 61 years. Participants’ hypertension status was categorized as controlled (normal blood pressure with use of antihypertensive drugs) or uncontrolled (high blood pressure, defined as 140/90 or greater, with use of antihypertensive drugs), and was determined by blood pressure measurements taken at some point, three months before they were hospitalized for an aneurysm.

The analysis found that 32% of participants taking RAAS inhibitors had ruptured intracranial aneurysms, compared with 67% of those using non-RAAS inhibitors.

“We were surprised to find that even among people with controlled hypertension, those taking RAAS inhibitors still had a significantly lower risk of rupture than people using non-RAAS inhibitors. Our study highlights that the “Using the appropriate antihypertensive drugs to achieve blood pressure normalization can remarkably decrease the risk of aneurysm rupture,” Huang said.

“Based on these data, we estimate that nearly 18% of ruptured aneurysms could be prevented if all patients with high blood pressure and intracranial aneurysms were prescribed RAAS inhibitors. Due to the strong potential benefit and of the high safety of RAAS inhibitors, these results could also help clinicians optimize therapy to help people with high blood pressure prevent aneurysm rupture.”

Using a multivariate model, the researchers calculated that the risk of aneurysm rupture in women was 1.8 times greater than the risk in men, and that the following factors increased the risk of aneurysm rupture. aneurysm:

  • uncontrolled hypertension;
  • exposure to second-hand smoke; and
  • untreated type 2 diabetes.

“These findings support previous studies indicating that in addition to blood pressure control, smoking cessation and aggressive treatment for type 2 diabetes may also help reduce the risk of aneurysm rupture,” Huang said. . “However, more research is needed to understand how RAAS inhibitors are involved in preventing intracranial aneurysm rupture in adults with high blood pressure.”


Journal reference:

Zhong, P. et al. (2022) Effect of renin-angiotensin-aldosterone system inhibitors on the risk of rupture in hypertensive patients with intracranial aneurysms. Hypertension.

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