Use of Antihypertensive Drugs and Ischemic Stroke Severity – Is There a Role for Angiotensin-IIReport as inadecuate




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Background

The 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.

Methods

From 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.

Results

A 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.

Conclusion

In 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.



Author: Wen Yea Hwong, Michiel L. Bots, Sharmini Selvarajah, Zariah Abdul Aziz, Norsima Nazifah Sidek, Wilko Spiering, L. Jaap Kappelle,

Source: http://plos.srce.hr/



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