Angiotensin-Receptor Blockers Prevent Vestibular Schwannoma-Associated Hearing Loss

Vestibular schwannoma (VS) tumors typically present with sensorineural hearing loss (SNHL). Losartan has recently demonstrated prevention of tumor-associated SNHL in a mouse model of VS through suppression of inflammatory and pro-fibrotic factors, and the current study investigates this association in humans.

This is a retrospective study of patients with unilateral VS and hypertension followed with sequential audiometry at a tertiary referral hospital from January 1994 to June 2023. Patients were stratified into subgroups by anti-hypertensive medication class. SNHL progression was assessed using Kaplan-Meier analysis to account for variable follow-up times.

Two hundred thirty-six patients were identified with diagnosis of both VS and hypertension, and with sequential audiometry. Of these, 186 were taking anti-hypertensive therapy at the time of initial VS diagnosis, and 23 were taking losartan or another angiotensin receptor blocker (ARB). Patients taking an ARB were both more likely to have normal baseline hearing and no progressive hearing loss with 36.5 total patient-years of follow-up. Patients taking other anti-hypertensives all showed expected declines in hearing consistent with natural history of VS tumors.

This study represents the first statistically significant association between ARB intake and hearing preservation in a real-world VS patient population. Significant confounding factors, such as concomitant hypertension in these patients, could still cloud the full effect of ARB medications' interaction with SNHL progression. Given that ARBs are well tolerated and safe, the results advocate for a prospective clinical trial to validate this effect.