Abstract TMP98: Pre-Stroke Use of Blood-Brain Barrier Crossing Angiotensin Receptor Blockers in Elderly Patients Mitigates Neurological Severity at the Onset of Acute Stroke

Abstract

Introduction: Functional outcomes after acute stroke (AS) are related to the initial neurological severity. Therefore, using neuroprotective agents to prevent or reduce brain damage shows promise as a preventive approach. Blood-brain barrier crossing (BBBc) angiotensin receptor blockers (ARBs) have been reported to reduce the risk of cognitive disorders. Therefore, BBBc ARBs may exert neuroprotective effects on brain damage caused by AS. However, the association between pre-stroke BBBc ARB use and neurological severity at the onset of AS has not been well studied. Hypothesis: Pre-stroke BBBc ARBs in elderly patients is linked to mild neurological severity (MNS) at the time of AS onset. Methods: We retrospectively included patients admitted within 24 hours of AS onset between January 2013 and March 2019 with available pre-stroke medication information. We defined MNS as a score of ≤5 points on the National Institutes of Health Stroke Scale. We conducted logistic regression analysis using variables for pre-stroke BBBc ARBs initiation, calculated propensity scores for pre-stroke BBBc ARBs use, and implemented one-to-one propensity score matching (PSM). The McNemar test assessed whether pre-stroke BBBc ARBs administration significantly affected MNS. Results: Out of 4294 patients with AS, 3472 met the inclusion criteria. Following one-to-one PSM, we identified 508 patients each in the BBBc ARBs usage and non-usage groups. The median ages of BBBc ARBs users and non-users were 80 and 81 years, respectively. Among the 508 BBBc ARBs users and the 508 non-users, 325 and 278 patients exhibited MNS, respectively (p=0.0027). Furthermore, the McNemar test revealed an asymmetrical binary matched pairs contingency table of MNS (p=0.0021), indicating a significant association between pre-stroke BBBc ARB use and MNS at the time of AS onset. Conclusions: The pre-stroke utilization of BBBc ARBs among elderly patients is associated with MNS at the onset of AS, implying potential neuroprotective effects against AS-induced brain damage. Further prospective studies are warranted to validate our findings and establish the practical application of BBBc ARBs for neuroprotection before AS.