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

Szupera, Zoltán and Czifra, György and Fülöp, Bence and Hermann, Zsuzsanna and Jassoy, Benjamin and Koszta, Alexandra and Kovács-Kusza, Katalin and Pordány-Bagoly, Edit and Singoszki, Szandra and Szegleti, Gábor and Varga, Vince and Kiss, Zoltán (2025) Association between angiotensin receptor blocker therapy and acute seizures in patients with stroke. IDEGGYOGYASZATI SZEMLE / CLINICAL NEUROSCIENCE, 78 (1-2). pp. 47-55. ISSN 0019-1442

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Abstract

Background and purpose – There aresome new results that the angiotensin receptor blockers (ARB) therapy may associatewith a lower risk of epilepsy. However, itspathomechanism and the patient characteristics are lacking. We asses, whether ARBtherapy is associates with lower incidence ofacute symptomatic seizures, compared withno ARB therapy in patients with acute stroke.Methods – There was a single-center, retrospective, observational cross-sectional study,enrolled patients with acute stroke admittedto our hospital, from 1 January 2019 to 31December 2021. The data source was ourhospital medical database. We allocated theenrolled patients into two groups, by receiving or not ARB therapy and defined a 7 daysexposure window after stroke onset whetheracute seizures appear. The primary outcomewas the incidence of acute seizures associated with ARB therapy compared with no ARBtherapy. The comparison of these groupswas performed with t-test for independentsamples. Analysis of seizure predictors wastested in univariable and multivariable logistic regression models.Results – 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 seizuresoccurred in 4 of 235 patients (1.70%) in theARB group and 78 of 1376 patients (5.67%)in the control group (P=0.014). In univariableanalysis the variables significantly associated with acute symptomatic seizures: ARB therapy (odds ratio [OR], 0.29; 95% CI, 0.10-0.79; p=0.016), and with inverse associationthe hemorrhagic stroke (OR, 1.60; 95% CI,1.50-4.52; p<0.001). In multivariable analysis, in addition to haemorrhage (OR, 2,46;95% CI, 1,41-4,40; p<0.001) the ARB therapyremains significant (OR, 0.33; 95% CI, 0.120.91; p=0.032) as an independent predictor.Conclusion – Due to our results the ARBtherapy associates with a lower incidenceof acute symptomatic seizures, which raisea question about its antiseizure property.Therefore, additional studies require to givemore evidences about advantage of ARBtherapy in these patients.

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