LOS ANGELES ― Angiotensin receptor blocker (ARB) drugs are more effective at preventing the development of epilepsy after stroke in patients with high blood pressure than other antihypertension medications, suggests a first-of-its-kind study presented at the American Epilepsy Society Annual Meeting.
Stroke is the most common cause of seizures in people 60 years or older. Previous research has shown that people who have high blood pressure are more likely to develop post-stroke epilepsy (PSE).
“Our study uniquely focused on how effective different blood pressure medications are at preventing PSE in the real world,” said Giacomo Evangelista, MD, PhD, co-lead author of the study and a resident in neurology at the Epilepsy Center at G. d’Annunzio University of Chieti-Pescara, Italy. “Understanding which antihypertensive medications help prevent complications such as PSE can lead to better patient outcomes.”
The study included 528 patients with high blood pressure who had suffered a stroke, none of whom had epilepsy at that time. All of the patients were taking some type of blood pressure medication. While most were taking one antihypertensive drug, 194 were taking two or more: 164 took beta-blockers (20 had PSE); 159 took calcium channel blockers (15 had PSE); 154 took angiotensin receptor agonists (ACE) inhibitors (10 had PSE); 136 took diuretics (8 had PSE); and 109 took ARBs (3 had PSE). Overall, 38 of the 528 patients (7.2%) developed PSE, most of whom were taking a single antihypertensive drug. The researchers determined that compared to those who took ARBs, patients who took other antihypertensive drugs were more likely to develop PSE: beta-blockers 120% more likely, calcium channel blockers 110% more likely; ACE inhibitors 65% more likely; and diuretics 60% more likely.
PSE occurs in 6%-8% of patients who have ischemic stroke, which typically is caused by a blockage in a blood vessel. A stroke may raise the risk of epilepsy by creating scarring in the brain that can lead to seizures.
The researchers say the ARBs may reduce the risk of PSE by blocking the angiotensin II type 1 receptor, a protein that causes the blood vessels to narrow, which raises blood pressure and increases the heart rate. Blocking this receptor may decrease inflammation and improve blood flow in the brain, reducing the risk of seizures. Calcium channel blockers and beta-blockers may increase the likelihood of seizures by inducing excessive excitability in the brain, which can trigger seizures.
ACE inhibitors reduce the production of angiotensin II type 1 receptors and may lead to inflammation that raises the risk of PSE.
“These findings highlight the importance of personalized medicine, particularly in managing blood pressure in stroke patients,” said Fedele Dono, MD, MSc, FEBN, co-lead author of the study and a neurologist at the Epilepsy Center, G. d’Annunzio University of Chieti-Pescara. “Further research in more patients is necessary to confirm these findings and explore the underlying mechanisms in more detail.”
*** AES 2024 news releases may contain updated data that does not match what is reported in the abstract.
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