A computer rendering of a ruptured aneurysm

Can long-standing antihypertensive drugs protect against brain aneurysm ruptures?

According to a Chinese study, the risks of intracranial aneurysm rupture were lower in people taking renin-angiotensin-aldosterone system (RAAS) blockers for hypertension.

In a multicenter database of more than 3,000 people with these aneurysms recorded in 2016-2021, rupture rates reached 23.4% among RAAS inhibitor users and 76.6% among nonusers , according to Qinghai Huang, MD, PhD, of Shanghai Hospital, Second Military Medical University, Shanghai, and colleagues.

Use of RAAS inhibitors was associated with a significantly reduced risk of intracranial aneurysm rupture (OR 0.490, 95% CI 0.402-0.597), and this applied to ACE inhibitors. angiotensin (ACE) (OR 0.559, 95% CI 0.442-0.709) and angiotensin receptor antagonists (ARB) (OR 0.414, 95% CI 0.315-0.542), they noted in Hypertension.

The decreased risk of rupture associated with RAAS inhibitors persisted across all subgroups by age, gender, BMI, control of hypertension, monotherapy and combination therapy, and location and size of intracranial aneurysms.

Huang and colleagues highlighted the relative safety and affordability of RAAS inhibitors and suggested that a randomized trial be conducted to confirm whether these drugs protect against aneurysm rupture.

Hypertension is a known risk factor for ruptured intracranial aneurysms, the cause of most subarachnoid hemorrhage strokes.

There is some evidence that RAAS activation may be involved in the pathogenesis of intracranial aneurysms, according to the study authors.

“In hypertension, RAAS has extensive effects on blood pressure regulation through sodium retention, pressure natriuresis, salt sensitivity, vasoconstriction, endothelial dysfunction, and vascular injury. Given these facts, in addition to directly increasing hemodynamic stresses, activation of the RAAS by systemic hypertension can cause vascular inflammation, injury and remodeling and thus contribute to the process of intracranial aneurysm rupture,” they explained.

Huang’s group, however, acknowledged that it is unclear how inhibiting RAAS would prevent the aneurysm from rupturing. A prospective study could shed light on the mechanism, they said.

For this retrospective study, the authors reviewed patient records at 20 Chinese academic medical centers.

Their database included 3,044 adults (mean age 61 years, 36.6% male) who were taking blood pressure medication and had an intracranial aneurysm, divided among those whose aneurysm had ruptured (n= 1,238) or had not ruptured (n = 1,806) at the time of analysis. Aneurysms can be treated by clipping, coiling and/or conservative treatment.

In a secondary analysis comparing 541 RAAS inhibitor users with the same number of nonusers, Huang’s group found that 17.7% of ruptured aneurysms would be prevented if all patients received RAAS inhibitors.

Besides non-use of RAAS inhibitors, other independent predictors of rupture included female gender, passive smoking, uncontrolled or unmonitored hypertension, hyperlipidemia, and aneurysmal location outside the carotid artery. internal.

“Our study significantly extends previous studies of blood pressure control, aggressive treatment of hyperlipidemia and diabetes, and avoidance of passive smoking as a second [prevention] for these patients,” the authors wrote.

Nevertheless, the retrospective study left room for residual confounding and the database lacked key clinical variables, such as blood pressure measurements and duration and dose of RAAS inhibitor treatment.

  • Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow

Disclosures

The study was funded by government grants from China.

Huang and his colleagues did not disclose anything.


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