RAAS inhibitor use may lower risk for intracranial aneurysm rupture in hypertension
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Renin-angiotensin-aldosterone system inhibitor use in patients with hypertension and intracranial aneurysm was associated with lower risk for aneurysm rupture compared with nonuse, according to research published in Hypertension.
“Approximately half of patients with intracranial aneurysms have high blood pressure, which can cause vascular inflammation and increase the risk of aneurysm rupture,” Qinghai Huang, MD, PhD, professor of neurosurgery at Changhai Hospital, Second Military Medical University in Shanghai, said in press release. “Given that one-third of patients with ruptured aneurysms die and another third remain dependent for daily life activities, there is a need to identify modifiable risk factors to prevent aneurysm rupture.”
Therefore, researchers conducted a multicenter chart review of 3,044 patients with hypertension and intracranial aneurysms at 20 centers in China (mean age, 61 years; 63% women).
Patients were classified as having a ruptured or unruptured aneurysm to better understand the relationship between rupture risk and renin-angiotensin-aldosterone system (RAAS) inhibitor use as well as risk tied to modifiable risk factors.
A total of 1,238 patients had a rupture while 1,806 did not.
Independent risk factors associated with aneurysm rupture included female sex, passive smoking, uncontrolled or unmonitored hypertension, use of more than two antihypertensive medications, use of antihyperglycemic agents, treated or untreated hyperlipidemia, ischemic stroke, middle cerebral artery location and anterior cerebral arteries/posterior communicating artery/posterior circulation (P for all < .05).
Researchers reported that use of RAAS inhibitors was associated with lower risk for aneurysm rupture compared with use of non-RAAS inhibitors (OR = 0.49; 95% CI, 0.402-0.597; P < .001).
Both ACE inhibitors (OR = 0.559; 95% CI, 0.442-0.709; P < .001) and angiotensin receptor blockers (OR = 0.414; 95% CI, 0.315-0.542; P < .001) were associated with lower risk for aneurysm rupture compared with non-RAAS inhibitors.
“Based on these data, we estimate that nearly 18% of ruptured aneurysms may be prevented if all patients with high blood pressure and intracranial aneurysms were prescribed with RAAS inhibitors,” Huang said in the release. “Due to the strong potential benefit and high safety of RAAS inhibitors, these findings may also help clinicians to optimize treatment to help people with high blood pressure prevent aneurysm rupture.”
The researchers also reported that these findings were consistent across all patient subgroups.
“We were surprised to find that even among people with controlled hypertension, those who took RAAS inhibitors still had a significantly lower rupture risk than individuals who used non-RAAS inhibitors,” Huang said in the release. “Our study highlights that using the proper antihypertensive medications to achieve normalization of blood pressure may remarkably decrease the risk of a ruptured aneurysm.”
Reference:
- Some blood pressure medicine may decrease the aneurysm rupture risk for people with high blood pressure. newsroom.heart.org/news/some-blood-pressure-medicine-may-decrease-the-aneurysm-rupture-risk-for-people-with-high-blood-pressure. Published June 3, 2022. Accessed June 3, 2022.
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