Angiotensin Receptor Blockers Linked to Reduced Epilepsy Incidence

On FRIDAY, June 21, 2024, a significant development in medical research was highlighted in JAMA Neurology. A study led by Xuerong Wen, Ph.D., from the University of Rhode Island in Kingston, revealed that angiotensin receptor blockers (ARBs) are linked with a lower incidence of epilepsy among patients suffering from hypertension compared to other antihypertensive medications.

The research team conducted a retrospective cohort study to investigate the relationship between ARB usage and the occurrence of epilepsy in various subgroups of American patients diagnosed with hypertension. The study compared patients who were administered ARBs with those who received other common antihypertensive drugs such as angiotensin-converting enzyme inhibitors (ACEIs), β-blockers, and calcium channel blockers (CCBs).

The study involved an extensive sample size. A total of 309,978 patients were treated with ARBs, while 807,510 received ACEIs, 695,887 were given β-blockers, and 448,589 were administered CCBs. For a more precise analysis, the researchers employed a propensity score (PS) matching method. This resulted in 1:1 PS-matched subgroups comprising 619,858 patients for ARB versus ACEI, 619,828 patients for ARB versus β-blocker, and 601,002 patients for ARB versus CCB.

The findings were noteworthy. The incidence of epilepsy was significantly lower in patients using ARBs compared to those on ACEIs, β-blockers, and other combined antihypertensive classes. The adjusted hazard ratios were 0.75 for ARBs versus ACEIs, 0.70 for ARBs versus β-blockers, and 0.72 for ARBs versus other combinations. The research indicated a particularly strong correlation in patients who had no prior history of stroke or cardiovascular disease, with losartan being the primary ARB associated with this effect.

The authors of the study emphasized the need for further pharmacological research. They suggest that randomized clinical trials are essential to confirm the potential antiepileptogenic properties of antihypertensive medications. This could open new avenues for treatment strategies in hypertensive patients at risk of developing epilepsy.

However, it is important to note that two of the authors disclosed connections to the pharmaceutical and medical device industries, which is a common practice in clinical research to maintain transparency and address any potential conflicts of interest.

In summary, this study sheds light on the potential benefits of ARBs beyond their primary role in managing hypertension. If further research confirms these findings, it could lead to significant changes in the treatment protocols for hypertensive patients, potentially reducing the incidence of epilepsy in this population.