Angiotensin Receptor Blockers May Prevent Epilepsy in Patients With Hypertension

Patients with arterial hypertension who received angiotensin receptor blocker therapy had a lower incidence of epilepsy.

Treatment using angiotensin receptor blockers (ARBs) reduced the incidence of epilepsy in patients with arterial hypertension, according to study findings published in JAMA Neurology.

Studies indicate that increased arterial hypertension correlates with increased incidence of epilepsy; however, research from animal studies indicates that ARBs may reduce epileptic seizures.

Researchers conducted a retrospective cohort study across 1274 general clinics between January 2010 and December 2020 in Germany to see if ARBs reduced the incidence of epilepsy in humans diagnosed with hypertension over a 5-year period. They included 168,612 patients with hypertension, dividing them evenly into 4 groups (42,153 in each group) based on which of the 4 antihypertensive drug treatments they received.

The 4 antihypertensive drug classes included beta-blockers, ARBs, angiotensin converting enzyme (ACE) inhibitors, and calcium channel blockers (CCBs).

Findings of this study suggest that antihypertensive drugs may be a novel approach for preventing epilepsy in patients with arterial hypertension.

The researchers discovered that incidence of epilepsy was indeed lowest among patients receiving ARB treatment. Of the 42,153 patients receiving treatment with ARBs, only 0.27% experienced seizures after 1 year, 0.63% after 3 years, and 0.99% after 5 years.

Patients treated with beta-blockers and CCBs demonstrated the highest incidence of epileptic seizures. Of the 42,153 patients receiving treatment with beta-blockers, 0.38% experienced seizures after 1 year, 0.91% after 3 years, and 1.47% after 5 years.

Similarly, of the 42,153 patients receiving treatment with CCBs, 0.38% experienced seizures after 1 year, 0.93% after 3 years, and 1.48% after 5 years.

When comparing the 4 drug classes, all ARB therapies as a group correlated significantly with a decreased incidence of epilepsy (hazard ratio [HR]: 0.77; 95% CI, 0.65-0.90; P <.002).

Overall, the researchers found a lower incidence of epilepsy among patients with hypertension was associated with ARB therapy.

The researchers concluded that the “Findings of this study suggest that antihypertensive drugs may be a novel approach for preventing epilepsy in patients with arterial hypertension.”

Study limitations included lack of normalization of patients per use of antihypertensives, potential bias since prescribing ARBs does not follow prescribing behavior in Germany, lack of randomization of patients to the 4 different drug groups, potential misclassification using ICD-10 codes, and lack of classification of cerebrovascular disease severity. Additionally, patients may have been taking multiple antihypertensives, and the researchers did not collect any data regarding lifestyle factors which may have also influenced hypertension status.

References:

Doege C, Luedde M, Kostev K. Association between angiotensin receptor blocker therapy and incidence of epilepsy in patients with hypertension. JAMA Neurol. Published online October 17, 2022. doi:10.1001/jamaneurol.2022.3413