Usage of Angiotensin-Converting Enzyme Inhibitor or Angiotensin II Receptor Blocker in Hypertension Intracerebral Hemorrhage

Chao Zhang; Jun Zhong; Wei-Xiang Chen; Xu-Yang Zhang; Yu-Hong Li; Teng-Yuan Zhou; Yong-Jie Zou; Chuan Lan; Lan Li; Zhao-Pan Lai; Hua Feng; Rong Hu

doi:10.2147/NDT.S291624

Usage of Angiotensin-Converting Enzyme Inhibitor or Angiotensin II Receptor Blocker in Hypertension Intracerebral Hemorrhage

Neuropsychiatr Dis Treat. 2021 Feb 9:17:355-363. doi: 10.2147/NDT.S291624. eCollection 2021.

Authors

Chao Zhang¹, Jun Zhong¹, Wei-Xiang Chen¹, Xu-Yang Zhang¹, Yu-Hong Li¹, Teng-Yuan Zhou¹, Yong-Jie Zou¹, Chuan Lan¹, Lan Li¹, Zhao-Pan Lai¹, Hua Feng¹, Rong Hu¹

Affiliation

¹ Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, People's Republic of China.

Abstract

Background: Inflammation plays an essential role in secondary brain injury after intracerebral hemorrhage (ICH). Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) have been suggested to suppress neuroinflammation after central nervous system (CNS) damage in animal models. However, the role of ACEIs and ARBs in ICH patients with hypertension remains unresolved in clinic. The aim of the present study is to evaluate the effect of ACEIs/ARBs on ICH patients with hypertension using a retrospective, single-center data analysis.

Methods: ICH patients diagnosed by computerized tomographic (CT) at Southwest Hospital, Third Military Medical University were included in the present research from January 2015 to December 2019. According to the medical history for the usage of antihypertensive drugs, patients were assigned into either ACEIs/ARBs group or non-ACEIs/ARBs group. Demographics, clinical baseline, radiological documents and treatments were collected and these data were statistically analyzed between the two groups.

Results: A total of 635 ICH patients with hypertension were included and allocated into 2 groups according to the usage of antihypertensive drugs: 281 in the ACEIs/ARBs group and 354 in the non-ACEIs/ARBs group. The results presented that the 3-months mortality and prevalence of ICH-associated pneumonia were lower in ACEIs/ARBs group than that in non-ACEIs/ARBs group (5.0% vs 11.9%, p=0.002; 58.4% vs 66.7%, p=0.031). While, there was no significant difference in favorable outcome (40.2% vs 33.9%, p=0.101) between the two groups. Furthermore, patients in ACEIs/ARBs group exhibited significantly less perihematomal edema volume on days 3 (23.5 ± 14.4 versus 28.7 ± 20.1 mL, p=0.045) and 7 (21.0 ± 13.7 versus 25.7 ± 17.6 mL, p=0.044), compared to that in non- ACEIs/ARBs group.

Conclusion: The usage of ACEIs/ARBs helps decrease mortality, perihematomal edema volume, and prevalence of ICH-associated pneumonia in ICH patients with hypertension.

Keywords: ICH-associated pneumonia; angiotensin II receptor blocker; angiotensin-converting enzyme inhibitor; inflammation; intracerebral hemorrhage.

Grants and funding

This work was supported by grants from National Key R&D Program of China (No. 2017YFC0111900) and Program for Innovation Research Group of Universities in Chongqing (No. CXQT19012).