Can Long-Term Blood Pressure Medications Protect Against Brain Aneurysm Ruptures?

The odds of developing intracranial aneurysms were lower in people taking renin-angiotensin-aldosterone system (RAAS) inhibitors for hypertension, a Chinese study showed.

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

The use of RAAS inhibitors was associated with a significantly reduced risk of intracranial aneurysm rupture (OR 0.490, 95% CI 0.402-0.597), as was angiotensin-converting enzyme (ACE) inhibitors (OR 0.559, 95% CI 0.442- 0.709). ) and angiotensin receptor blockers (ARBs) equal (OR 0.414, 95% CI 0.315-0.542), they noted in hypertension†

The reduced rupture risk associated with RAAS inhibitors was maintained in subgroups by age, gender, BMI, control of hypertension, monotherapy and combination therapy, and location and size of intracranial aneurysms.

Huang and colleagues emphasized the relative safety and affordability of RAAS inhibitors and suggested conducting a randomized trial to confirm whether these drugs protect against aneurysm rupture†

Hypertension is a known risk factor for intracranial aneurysm rupture, the cause of most subarachnoidal haemorrhage to succeed.

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

“In hypertension, the RAAS has broad 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 may cause vascular inflammation, injury and cause remodeling and thereby contribute to the process of intracranial aneurysm rupture,” they explained.

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

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

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

In a secondary analysis, comparing 541 users of RAAS inhibitors to the same number of non-users, Huang’s group found that 17.7% of ruptured aneurysms would be prevented if all patients were prescribed RAAS inhibitors.

In addition to not using RAAS inhibitor, other independent predictors of rupture include female gender, secondhand smoke, uncontrolled or uncontrolled hypertension, hyperlipidemia, and aneurysmal location outside the internal carotid artery.

“Our study is an important extension of previous studies on blood pressure control, the aggressive treatment of hyperlipidemia and diabetes, and second-hand smoke avoidance.” [prevention] for these patients,” the authors wrote.

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