Use of antihypertensive medication and formation of de novo intracranial aneurysms

• Published in: European journal of neurology Vol. 29; no. 9; pp. 2708 - 2715
• Main Authors: Räisänen, Sari, Huttunen, Jukka, Huuskonen, Terhi J., Fraunberg, Mikael, Koivisto, Timo, Jääskeläinen, Juha E., Frösen, Juhana, Lindgren, Antti
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.09.2022
• Subjects: Aneurysm; Aneurysm, Ruptured - complications; Aneurysms; antihypertensive agent; Antihypertensive Agents - therapeutic use; Antihypertensives; Cohort Studies; de novo aneurysm; Diagnosis; Drugs; Hemorrhage; Humans; Hypertension; Hypertension - complications; Hypertension - drug therapy; Hypertension - epidemiology; intracranial aneurysm; Intracranial Aneurysm - complications; Intracranial Aneurysm - drug therapy; Intracranial Aneurysm - epidemiology; Multivariate analysis; Risk analysis; Risk factors; Saccule; Subarachnoid hemorrhage; Subarachnoid Hemorrhage - complications; Subarachnoid Hemorrhage - epidemiology; de novo aneurysm; intracranial aneurysm; hypertension; antihypertensive agent; subarachnoid hemorrhage
• ISSN: 1351-5101; 1468-1331; 1468-1331
• DOI: 10.1111/ene.15430

Background and purpose Hypertension is a risk factor for subarachnoid hemorrhage and is also considered a risk factor for saccular intracranial aneurysm (sIA) formation. However, there is little direct evidence that antihypertensive medication will reduce sIA formation. Methods The impact of antihypertensive medication on de novo sIA formation was studied in an angiographically followed cohort of 1419 patients. Patients were identified from our population‐based Kuopio Intracranial Aneurysm Database, and data on the purchases of antihypertensive medication were obtained from a national registry. Univariate and multivariate analyses were used to investigate the risk factors. Results Of the 966 sIA patients who were prescribed with antihypertensive medication, 841 patients used the medication regularly; 20 of them had de novo sIA. One hundred and twenty‐five patients used the medication irregularly and 12 of them developed de novo sIAs. Four hundred and fifty‐three patients did not use antihypertensive medication even though 27 of them had a diagnosis of hypertension, and 10 of them developed de novo sIAs. In the multivariate analysis antihypertensive medication did not significantly reduce de novo sIA formation (hazard ratio [HR] 1.60, 95% confidence interval [CI] 0.84–3.06). Age at primary diagnosis (HR: 0.95, 95%: CI 0.93–0.98) and smoking history (HR: 5.53, 95% CI: 2.77–11.05) were significant risk factors for de novo sIA formation. Also, irregular usage of antihypertensive medication was a significant risk factor (HR: 3.84, 95% CI: 1.59–9.29) for de novo sIA formation. Conclusions Antihypertensive agents were not associated with a reduction of de novo sIA formation, but irregular use of antihypertensive agents was associated with an increased risk of de novo sIA formation. Impact of antihypertensive medication on de novo sIA formation was studied in a cohort of 1419 sIA patients. Use of antihypertensive medication was not significantly associated with de novo aneurysm formation, whereas smoking and young age at primary diagnosis were. However, amongst patients with prescribed antihypertensive medication, irregular use of the medication increased the risk for de novo aneurysm formation compared to regular use.