Angiotensin Inhibition Reduces the Risk of Subarachnoid Hemorrhage in Patients With Hypertension
Background Local angiotensin activity is thought to play a critical role in arterial wall homeostasis and remodeling, and impaired arterial wall integrity contributes to the pathogenesis of subarachnoid hemorrhage (SAH). Here we aimed to assess the association between pharmacologic inhibition of ang...
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Wiley
2025-01-01
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| Series: | Stroke: Vascular and Interventional Neurology |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/SVIN.124.001482 |
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| author | Mohammad Hossein Abbasi Colleen M. Brensinger Emily K. Acton Christopher G. Favilla Jan‐Karl Burkhardt Scott E. Kasner |
| author_facet | Mohammad Hossein Abbasi Colleen M. Brensinger Emily K. Acton Christopher G. Favilla Jan‐Karl Burkhardt Scott E. Kasner |
| author_sort | Mohammad Hossein Abbasi |
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| description | Background Local angiotensin activity is thought to play a critical role in arterial wall homeostasis and remodeling, and impaired arterial wall integrity contributes to the pathogenesis of subarachnoid hemorrhage (SAH). Here we aimed to assess the association between pharmacologic inhibition of angiotensin‐converting enzyme and subsequent nontraumatic SAH. Methods In a retrospective cohort study based on Optum's Clinformatics Datamart deidentified database records (2000–2021), we included all subjects with a history of hypertension. We collected medication history, and the exposure of interest was the use of an angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARB). The primary outcome was the subsequent development of nontraumatic SAH. Cox proportional hazard regression models were used to compare the time to SAH by type of antihypertensive treatment. Results A total of 7.5 million patients with hypertension were assessed. Patients on ACEI/ARBs with or without other antihypertensives (n = 4.8 million, follow‐up: 6.3 years) had lower rates of SAH compared with those on alternative antihypertensive regimens (n = 1.3 million, follow‐up: 5.7 years) (hazard ratio [HR]:0.94 [0.91–0.97]; P<0.0001), as well as compared with those on no antihypertensive medications (n = 1.4 million, follow‐up: 5.3 years) (HR:0.94 [0.91–0.97]; P = 0.0002). However, antihypertensive medications other than ACEI/ARBs were not associated with SAH risk compared with treatment by no antihypertensives (HR:1.00 [0.97–1.04]; P = 0.83). Among 8034 patients with known unruptured intracerebral aneurysms, no difference in SAH with ACEI/ARBs was observed compared to alternative antihypertensive regimens (HR:1.04 [0.95–1.13]) or no antihypertensive therapy (HR:1.06 [0.97–1.16]). Uninterrupted ACEI/ARBs use for ≥3 years reduced the risk of SAH by 23%, compared with treatment by only other hypertensives (HR:0.71 [0.68–0.74]; P<0.001). Conclusion Treatment of hypertension with ACEI/ARBs was associated with a lower risk of SAH than other types of antihypertensive agents, particularly with longer courses of therapy. |
| format | Article |
| id | doaj-art-09058f60287e4dd6b2f5841ba8bfa279 |
| institution | Kabale University |
| issn | 2694-5746 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wiley |
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| series | Stroke: Vascular and Interventional Neurology |
| spelling | doaj-art-09058f60287e4dd6b2f5841ba8bfa2792025-01-11T08:01:41ZengWileyStroke: Vascular and Interventional Neurology2694-57462025-01-015110.1161/SVIN.124.001482Angiotensin Inhibition Reduces the Risk of Subarachnoid Hemorrhage in Patients With HypertensionMohammad Hossein Abbasi0Colleen M. Brensinger1Emily K. Acton2Christopher G. Favilla3Jan‐Karl Burkhardt4Scott E. Kasner5Department of Neurology Perelman School of Medicine University of Pennsylvania Philadelphia PACenter for Clinical Epidemiology and Biostatistics Perelman School of Medicine University of Pennsylvania Philadelphia PADepartment of Neurology Perelman School of Medicine University of Pennsylvania Philadelphia PADepartment of Neurology Perelman School of Medicine University of Pennsylvania Philadelphia PADepartment of Neurosurgery Perelman School of Medicine University of Pennsylvania Philadelphia PADepartment of Neurology Perelman School of Medicine University of Pennsylvania Philadelphia PABackground Local angiotensin activity is thought to play a critical role in arterial wall homeostasis and remodeling, and impaired arterial wall integrity contributes to the pathogenesis of subarachnoid hemorrhage (SAH). Here we aimed to assess the association between pharmacologic inhibition of angiotensin‐converting enzyme and subsequent nontraumatic SAH. Methods In a retrospective cohort study based on Optum's Clinformatics Datamart deidentified database records (2000–2021), we included all subjects with a history of hypertension. We collected medication history, and the exposure of interest was the use of an angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARB). The primary outcome was the subsequent development of nontraumatic SAH. Cox proportional hazard regression models were used to compare the time to SAH by type of antihypertensive treatment. Results A total of 7.5 million patients with hypertension were assessed. Patients on ACEI/ARBs with or without other antihypertensives (n = 4.8 million, follow‐up: 6.3 years) had lower rates of SAH compared with those on alternative antihypertensive regimens (n = 1.3 million, follow‐up: 5.7 years) (hazard ratio [HR]:0.94 [0.91–0.97]; P<0.0001), as well as compared with those on no antihypertensive medications (n = 1.4 million, follow‐up: 5.3 years) (HR:0.94 [0.91–0.97]; P = 0.0002). However, antihypertensive medications other than ACEI/ARBs were not associated with SAH risk compared with treatment by no antihypertensives (HR:1.00 [0.97–1.04]; P = 0.83). Among 8034 patients with known unruptured intracerebral aneurysms, no difference in SAH with ACEI/ARBs was observed compared to alternative antihypertensive regimens (HR:1.04 [0.95–1.13]) or no antihypertensive therapy (HR:1.06 [0.97–1.16]). Uninterrupted ACEI/ARBs use for ≥3 years reduced the risk of SAH by 23%, compared with treatment by only other hypertensives (HR:0.71 [0.68–0.74]; P<0.001). Conclusion Treatment of hypertension with ACEI/ARBs was associated with a lower risk of SAH than other types of antihypertensive agents, particularly with longer courses of therapy.https://www.ahajournals.org/doi/10.1161/SVIN.124.001482ACEIangiotensinARBhypertensionintracranial aneurysmsubarachnoid hemorrhage |
| spellingShingle | Mohammad Hossein Abbasi Colleen M. Brensinger Emily K. Acton Christopher G. Favilla Jan‐Karl Burkhardt Scott E. Kasner Angiotensin Inhibition Reduces the Risk of Subarachnoid Hemorrhage in Patients With Hypertension Stroke: Vascular and Interventional Neurology ACEI angiotensin ARB hypertension intracranial aneurysm subarachnoid hemorrhage |
| title | Angiotensin Inhibition Reduces the Risk of Subarachnoid Hemorrhage in Patients With Hypertension |
| title_full | Angiotensin Inhibition Reduces the Risk of Subarachnoid Hemorrhage in Patients With Hypertension |
| title_fullStr | Angiotensin Inhibition Reduces the Risk of Subarachnoid Hemorrhage in Patients With Hypertension |
| title_full_unstemmed | Angiotensin Inhibition Reduces the Risk of Subarachnoid Hemorrhage in Patients With Hypertension |
| title_short | Angiotensin Inhibition Reduces the Risk of Subarachnoid Hemorrhage in Patients With Hypertension |
| title_sort | angiotensin inhibition reduces the risk of subarachnoid hemorrhage in patients with hypertension |
| topic | ACEI angiotensin ARB hypertension intracranial aneurysm subarachnoid hemorrhage |
| url | https://www.ahajournals.org/doi/10.1161/SVIN.124.001482 |
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