Anti Hypertensives reducing the Aneurysm Rupture risk

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

An aneurysm is a bulging or weakening in the wall of an artery. When this happens in an artery in 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 a hemorrhagic stroke, coma and death. These strokes account for 3-5% of all strokes, but a larger proportion of morbidity and mortality than other types of strokes. Each year, approximately 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's 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 found 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.

More than 3,000 adults with high blood pressure and intracranial aneurysms were included in the study. The study sample was one-third men and two-thirds women, with an average age of 61 years old. Participants' hypertension status was categorized as controlled (normal blood pressure with the use of antihypertensive medications) or uncontrolled (high blood pressure, defined as 140/90 or above, with the use of antihypertensive medications), and was determined by blood pressure measurements taken at one point in time, three months before they were hospitalized for an aneurysm.

The analysis found that 32% of participants who took RAAS inhibitors experienced an intracranial aneurysm rupture, compared to 67% of those who used non-RAAS inhibitors.

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

● uncontrolled hypertension;

● exposure to second-hand smoke; and

● untreated Type 2 diabetes.