Association between angiotensin receptor blocker therapy and acute seizures in patients with stroke

There are some new results that the angiotensin receptor blockers (ARB) therapy may associate with a lower risk of epilepsy. However, its pathomechanism and the patient characteristics are lacking. We asses, whether ARB therapy is associates with lower incidence of acute symptomatic seizures, compared with no ARB therapy in patients with acute stroke.

There was a single-center, retrospective, observational cross-sectional study, enrolled patients with acute stroke admitted to our hospital, from 1 January 2019 to 31 December 2021. The data source was our hospital medical database. We allocated the enrolled patients into two groups, by receiving or not ARB therapy and defined a 7 days exposure window after stroke onset whether acute seizures appear. The primary outcome was the incidence of acute seizures associated with ARB therapy compared with no ARB therapy. The comparison of these groups was performed with t-test for independent samples. Analysis of seizure predictors was tested in univariable and multivariable logistic regression models.

The study included 1611 patients, mean [SD] age was 72.1 [±13.3] years; 801 (49.7%) were women, and 811 (50.3%) were men. The acute symptomatic seizures occurred in 4 of 235 patients (1.70%) in the ARB group and 78 of 1376 patients (5.67%) in the control group (P=0.014). In univariable analysis the variables significantly associated with acute symptomatic seizures: ARB the-rapy (odds ratio [OR], 0.29; 95% CI, 0.10-0.79; p=0.016), and with inverse association the hemorrhagic stroke (OR, 1.60; 95% CI, 1.50-4.52; p<0.001). In multivariable analy-sis, in addition to haemorrhage (OR, 2,46; 95% CI, 1,41-4,40; p<0.001) the ARB therapy remains significant (OR, 0.33; 95% CI, 0.12-0.91; p=0.032) as an independent predictor.

Due to our results the ARB therapy associates with a lower incidence of acute symptomatic seizures, which raise a question about its antiseizure property. Therefore, additional studies require to give more evidences about advantage of ARB therapy in these patients.