Pre-AIS RAS inhibitor exposure tied to less severe stroke, fewer bleeding events

Acute ischaemic stroke (AIS) patients receiving blood pressure (BP)-lowering treatment with renin-angiotensin system (RAS) inhibitors before the index event exhibit less severe stroke and develop intracranial haemorrhage less frequently compared with those on non-RAS inhibitors prior to stroke, according to a study.

The study was a post hoc analysis of the BP TARGET trial (Blood Pressure Target in Acute Stroke to Reduce Hemorrhage After Endovascular Therapy) and included 203 AIS patients with hypertension and receiving treatment with BP-lowering drugs at admission. Antihypertensive treatment was categorized as RAS inhibitors (eg, ACE [angiotensin-converting enzyme] inhibitors, ARBs [angiotensin 2 receptor blockers], and β-blockers) and non-RAS inhibitors (eg, calcium channel blockers and diuretics).

Researchers analysed the associations of each category of BP-lowering treatment with the following outcomes: National Institutes of Health Stroke Scale (NIHSS) score at baseline, 24-hour NIHSS change, and intracranial haemorrhage.

NIHSS score at baseline was high in the non-RAS group (adjusted mean difference, 3.28, 95 percent confidence interval [CI], 1.33–5.22; p=0.001) and low in the RAS group (adjusted mean difference, −2.81, 95 percent CI, −5.37 to −0.25; p=0.031).

The odds of intracranial haemorrhage were more than twofold higher in the non-RAS group (adjusted odds ratio, 2.48, 95 percent CI, 1.12–5.47; p=0.025). Conversely, the use of RAS inhibitor treatments before AIS was not associated with higher odds of radiographic intracranial haemorrhage.

Finally, NIHSS at 24 hours only had a small improvement among patients receiving non-RAS inhibitor treatment vs those who were receiving no treatment (adjusted mean difference, 2.83, 95 percent CI, −0.16 to 5.81; p=0.063).

Baseline RAS inhibitor or noninhibitor treatments were not related to a favourable outcome.