Atlanta—RAAS inhibitors, a class of blood pressure—lowering medicine, appear to be more effective at reducing the risk of brain aneurysm rupture, according to a new study.

The AHA reports that brain aneurysm patients being treated for high blood pressure with RAAS inhibitors had an 18% lower risk of a ruptured aneurysm compared with those who were prescribed other blood pressure medications.

"These results indicate that RAAS inhibitors may be preferable to other blood pressure-lowering medications and could inform treatment decisions for people with high blood pressure who have unruptured intracranial aneurysms," the AHA said in a press release.

The possible recommendation was based on a multicenter study of more than 3,000 patients with concurrent hypertension and brain aneurysms. Results were published in Hypertension.

The Chinese researchers wrote, "Mounting experimental evidence supports the concept that the RAAS (renin-angiotensin-aldosterone system) is involved in the pathogenesis of intracranial aneurysm rupture. However, whether RAAS inhibitors could reduce the rupture risk of intracranial aneurysms remains unclear."

In response, the study team performed a chart review of a multicenter, prospectively maintained database of 3,044 hypertensive patients with intracranial aneurysms from 20 medical centers in China. The patients were separated into ruptured and unruptured groups.

In multivariable analyses, results indicate that female sex, passive smoking, uncontrolled or unmonitored hypertension, use of over two antihypertensive medications, RAAS inhibitors use, antihyperglycemic agents use, hyperlipidemia, ischemic stroke, and aneurysmal location had an effect on rupture risk.

"The use of RAAS inhibitors was significantly associated with a reduced rupture risk compared with the use of non-RAAS inhibitors (odds ratio, 0.490 [95% CI, 0.402-0.597]; P = .000)," the authors advised. "Compared with the use of non-RAAS inhibitors, the use of ACE (angiotensin-converting enzyme) inhibitors (odds ratio, 0.559 [95% CI, 0.442-0.709]; P = .000) and use of ARBs (angiotensin receptor blockers; odds ratio, 0.414 [95% CI, 0.315-0.542]; P = .000) were both significantly associated with a reduced rupture risk. The negative association of the rupture risk with RAAS inhibitors was consistent across 3 analyzed data and the predefined subgroups (including controlled hypertension)."

The study concluded that the use of RAAS inhibitors is significantly associated with a decreased rupture risk, despite the effectiveness of blood pressure control among hypertensive patients with intracranial aneurysms.

"Approximately half of patients with intracranial aneurysms have high blood pressure, which can cause vascular inflammation and increase the risk of aneurysm rupture," explained the study's senior author Qinghai Huang, MD, PhD, 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."

The study team determined that approximately 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. Our study highlights that using the proper antihypertensive medications to achieve normalization of blood pressure may remarkably decrease the risk of a ruptured aneurysm," Dr. Huang stated.

Dr. Huang added, "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 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."

The researchers calculated the risk of aneurysm rupture was 1.8 times higher in women than men, with the following factors increasing the risk:

• Uncontrolled hypertension
• Exposure to second-hand smoke
• 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," Dr. Huang stated. "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."

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