Abstract
BackgroundThe increase in angiotensin II (Ang II) formation by selected antihypertensive drugs is said to exhibit neuroprotective properties, but this translation into improvement in clinical outcomes has been inconclusive. We undertook a study to investigate the relationship between types of antihypertensive drugs used prior to a stroke event and ischemic stroke severity. We hypothesized that use of antihypertensive drugs that increase Ang II formation (Ang II increasers) would reduce ischemic stroke severity when compared to antihypertensive drugs that suppress Ang II formation (Ang II suppressors).MethodsFrom the Malaysian National Neurology Registry, we included hypertensive patients with first ischemic stroke who presented within 48 hours from ictus. Antihypertensive drugs were divided into Ang II increasers (angiotensin-I receptor blockers (ARBs), calcium channel blockers (CCBs) and diuretics) and Ang II suppressors (angiotensin-converting-enzyme inhibitors (ACEIs) and beta blockers). We evaluated stroke severity during admission with the National Institute of Health Stroke Scale (NIHSS). We performed a multivariable logistic regression with the score being dichotomized at 15. Scores of less than 15 were categorized as less severe stroke.ResultsA total of 710 patients were included. ACEIs was the most commonly prescribed antihypertensive drug in patients using Ang II suppressors (74%) and CCBs, in patients prescribed with Ang II increasers at 77%. There was no significant difference in the severity of ischemic stroke between patients who were using Ang II increasers in comparison to patients with Ang II suppressors (OR: 1.32, 95%CI: 0.83–2.10, p = 0.24).ConclusionIn our study, we found that use of antihypertensive drugs that increase Ang II formation was not associated with less severe ischemic stroke as compared to use of antihypertensive drugs that suppress Ang II formation.
Highlights
There are no differences in the extent of blood pressure lowering between types of antihypertensive drugs, certain classes of drugs are postulated to potentially confer a greater amount of cerebroprotection than others.[1]
angiotensin-converting-enzymes inhibitors (ACEIs) was the most commonly prescribed antihypertensive drug in patients using angiotensin II (Ang II) suppressors (74%) and calcium channel blockers (CCBs), in patients prescribed with Ang II increasers at 77%
There was no significant difference in the severity of ischemic stroke between patients who were using Ang II increasers in comparison to patients with Ang II suppressors (OR: 1.32, 95%CI: 0.83–2.10, p = 0.24)
Summary
There are no differences in the extent of blood pressure lowering between types of antihypertensive drugs, certain classes of drugs are postulated to potentially confer a greater amount of cerebroprotection than others.[1]. Angiotensin-1 receptor blockers (ARBs), calcium channel blockers (CCBs) and diuretics are antihypertensive drugs that increase Ang II formation and these drugs are believed to have neuroprotective properties against ischemic stroke. This hypothesis was initially proposed by Fournier et al [1] after consistent findings of a reduction in stroke risk with ARBs, CCBs and diuretics in numerous clinical trials and similarity in terms of mechanism of Ang II formation in these drugs. The mechanism is slightly different for diuretics and CCBs where both drugs act by promoting renin secretion which subsequently increase Ang II formation Both angiotensin-converting-enzymes inhibitors (ACEIs) and beta blockers suppress renin secretion and decrease the formation of Ang II.[6]. We hypothesized that use of antihypertensive drugs that increase Ang II formation (Ang II increasers) would reduce ischemic stroke severity when compared to antihypertensive drugs that suppress Ang II formation (Ang II suppressors)
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