Study: Blood Pressure Drug May Lower Aneurysm Rupture Risk for People With High Blood Pressure

A study of more than 3000 patients with high blood pressure and brain aneurysms found that the use of renin-angiotensin-aldosterone system (RAAS) inhibitors, a class of blood pressure-lowering medications, lowered the risk of an aneurysm rupture by 18%.

The study, published in Hypertension, noted that the body’s RAAS includes hormones that affect blood pressure regulation, and the dysregulation of the RAAS can lead to the development of high blood pressure. Further, the investigators said that 2 components of RAAS are involved in the development of intracranial aneurysms, with prior research showing dysregulation of RAAS may lead to aneurysm rupture.

“Approximately half of patients with intracranial aneurysms have high blood pressure, which can cause vascular inflammation and increase the risk of aneurysm rupture,” said senior study senior author Qinghai Huang, MD, PhD, professor of neurosurgery at Changhai Hospital, Second Military Medical University in Shanghai, China, in a 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.”

The multi-center study looked at data collected between 2016 and 2021 at 20 different medical centers in multiple regions across China, collected pre- and post-rupture, to evaluate the link between the use of RAAS inhibitors and other blood pressure medications, including beta-blockers and diuretics, on the risk of aneurysm rupture.

The investigators analyzed more than 3000 adults with high blood pressure and intracranial aneurysms. One-third of the study sample were male and two-thirds were women with an average age of 61 years. Hypertension status, categorized as controlled or uncontrolled, was determined by blood pressure measurements taken 3 months before patients were hospitalized for aneurysm.

In the analysis, 32% of participants who took RAAS inhibitors experienced an intracranial aneurysm rupture compared with 67% of patients 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. Our study highlights that using the proper antihypertensive medications to achieve normalization of blood pressure may remarkably decrease the risk of a ruptured aneurysm,” Huang said in the press release. “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. 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.”

Factors that increased the risk of aneurysm rupture included 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,” Huang said in the press release. “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 study authors noted a few limitations, including the study’s retrospective nature, the existence of potential confounders, and the duration and dose of RAAS inhibitors was not recorded in the database.

REFERENCE

Some blood pressure medicine may decrease the aneurysm rupture risk for people with high blood pressure. American Heart Association. June 3, 2022. Accessed June 9, 2022. https://newsroom.heart.org/news/some-blood-pressure-medicine-may-decrease-the-aneurysm-rupture-risk-for-people-with-high-blood-pressure#:~:text=June%2003%2C%202022-,Some%20blood%20pressure%20medicine%20may%20decrease%20the%20aneurysm%20rupture,people%20with%20high%20blood%20pressure&text=Research%20Highlights%3A,risk%20of%20brain%20aneurysm%20rupture.