Use of RAAS Inhibitors Linked to Decreased Risk of Intracranial Aneurysm Rupture

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Use of RAAS Inhibitors Linked to Decreased Risk of Intracranial Aneurysm Rupture

The use of renin-angiotensin-aldosterone system (RAAS) inhibitors reduced the risk of an aneurysm rupture by 18% among patients with hypertension and intracranial aneurysms, according to a study 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,” said Qinghai Huang, MD, Changhai Hospital, Second Military Medical University, Shanghai, China. “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.”

This study analysed data collected from 2016 to 2021 at 20 medical centres in different regions across China, collected pre- and post-rupture, to evaluate the association among 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. Participants’ hypertension status was categorised as controlled (normal blood pressure with the use of antihypertensive medications) or uncontrolled (high blood pressure, defined as ≥140/90 with the use of antihypertensive medications), and was determined by blood pressure measurements taken at one point in time, 3 months before they were hospitalised for aneurysm.

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

“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,” said Dr. Huang. “Our study highlights that using the proper antihypertensive medications to achieve normalisation of blood pressure may remarkably decrease the risk of a ruptured aneurysm.”

”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,” he said. “Due to the strong potential benefit and high safety of RAAS inhibitors, these findings may also help clinicians to optimise treatment to help people with high blood pressure prevent aneurysm rupture.”

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.

“These findings confirm previous studies indicating that -- in addition to blood pressure control -- smoking cessation and aggressive treatment of type 2 diabetes may also help reduce the risk of aneurysm rupture,” said Dr. Huang. “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.”

The authors noted that limitations include the study’s retrospective nature, the existence of potential confounders, that hypertension was defined as a blood pressure of 140/90, rather than of 130/80, that the exact value of participants’ blood pressure was not taken and that the duration, and dose of RAAS inhibitors was not recorded in the database.

Reference: https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.122.18970

SOURCE: American Heart Association