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.
“Approximately half of patients with intracranial aneurysms have high blood pressure, which can cause vascular inflammation and increase the risk of aneurysm rupture,” said the study’s senior author Qinghai Huang, M.D., Ph.D., professor of neurosurgery at Changhai Hospital, Second Military Medical University in 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 multi-center study analyzed data collected from 2016 to 2021 at 20 medical centers 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. 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 aneurysm.
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