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

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

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

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

from the body renin-angiotensin-aldosterone system (RAAS) includes hormones that affect blood pressure regulation, and dysregulation of the 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, medications 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 a third of patients with a ruptured aneurysm die and another third remain dependent for daily activities, it is necessary to identify modifiable risk factors to prevent an aneurysm rupture.

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

This multi-center study analyzed data collected from 2016 to 2021 at 20 medical centers in different regions in China, collected before and after the breakup, to evaluate the association between the use of RAAS inhibitors and other blood pressure medications, including beta-blockers. and diuretics, on the risk of aneurysm rupture.

More than 3,000 adults with high blood pressure and intracranial aneurysms were included. The study group consisted of one third of men and two thirds of women, with an average age of 61 years. The hypertension status of the participants was categorized as controlled (normal blood pressure when taking antihypertensive drugs) or uncontrolled (high blood pressure, defined as 140/90 or higher, when taking antihypertensive drugs) and was determined by blood pressure measurements taken. at one point, three months before being hospitalized for an aneurysm.

The analysis found that 32% of participants taking RAAS inhibitors experienced an intracranial aneurysm rupture, compared with 67% of those taking non-RAAS inhibitors.

“We were surprised to find that even in people with controlled hypertension, those taking RAAS inhibitors still had a significantly lower risk of rupture than individuals taking non-RAAS inhibitors. normalizing blood pressure can significantly reduce the risk of a ruptured aneurysm,” Huang said.

“Based on these data, we estimate that almost 18% of ruptured aneurysms could be prevented if all patients with hypertension and intracranial aneurysms were given RAAS inhibitors. Because of the strong potential benefit and high safety of RAAS inhibitors, these The findings also help clinicians optimize treatment to help people with high blood pressure avoid aneurysm rupture.”

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

  • uncontrolled hypertension;
  • exposure to secondhand smoke; and
  • untreated type 2 diabetes.

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


Reference magazine:

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

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