Key points Are angiotensin receptor blockers associated with a lower incidence of epilepsy in patients with high blood pressure? Findings In this cohort study of 168,612 outpatients with arterial hypertension, the use of angiotensin receptor blockers was associated with a significantly lower incidence of epilepsy compared with other classes of antihypertensive drugs. Meaning The findings of this study suggest that the use of angiotensin receptor blockers in patients with arterial hypertension may be a novel approach for the prevention of epilepsy in this population. |
Importance
High blood pressure is associated with a higher incidence of epilepsy. Results from animal studies suggest that angiotensin receptor blocker (ARB) therapy may inhibit epileptic seizures. However, clinical data supporting the use of ARB therapy in humans is lacking.
Aim
To evaluate whether ARB therapy is associated with a lower incidence of epilepsy in patients with hypertension.
Design, environment and participants
This cohort study obtained data from the Disease Analyzer (IQVIA) database on patients aged 18 years or older who had hypertension and at least 1 prescription for antihypertensive medications.
Patients were treated in 1274 general practices between January 2010 and December 2020 in Germany. Data were available for 1,553,875 patients who had been prescribed at least 1 antihypertensive drug.
Patients diagnosed with epilepsy before or up to 3 months after the index date were excluded . A total of 168,612 patients were included in the propensity score matching.
Patients treated with 1 of 4 classes of antihypertensive drugs (β-blockers, ARBs, angiotensin-converting enzyme inhibitors, and calcium channel blockers [CCBs]) were compared with each other using propensity scores.
Main results and measures
The main outcome of the study was the incidence of epilepsy associated with ARB therapy compared with other classes of antihypertensive drugs. Cox regression models were used to study the association between epilepsy incidence and ARBs compared with all other antihypertensive drug classes as a group.
Results
The study included a total of 168,612 patients , with 42,153 in each antihypertensive drug class. The mean [SD] age of the patients was 62.3 [13.5] years, and 21,667 (51.4%) were women.
The incidence of epilepsy within 5 years was lowest among ARB-treated patients (0.27% at 1 year, 0.63% at 3 years, 0.99% at 5 years) and highest among patients who received β-blockers and CCBs (0.38% for both β-blockers and CCBs at 1 year; 0.91% for β-blockers and 0.93% for CCBs at 3 years; β-blockers 1.47% and BCC 1.48% at 5 years).
Angiotensin receptor blocker therapy was associated with a significantly lower incidence of epilepsy (hazard ratio, 0.77; 95% CI, 0.65-0.90) compared with the other drug classes. cluster.
Conclusions and relevance
|
