# Preventative Effect of Angiotensin Receptor Blockers on Moderate-to-Severe Cerebral Vasospasm Among Patients Who Received Interventions for Aneurysmal Subarachnoid Hemorrhage

## TL;DR

This study suggests that angiotensin receptor blockers may help prevent severe cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage.

## Contribution

The study provides evidence that ARBs may reduce the risk of moderate-to-severe cerebral vasospasm in aSAH patients.

## Key findings

- ARB administration was associated with a decreased risk of moderate-to-severe vasospasm.
- Fisher grade III–IV increased the risk of vasospasm independently.
- Older age was also found to independently decrease the risk of vasospasm.

## Abstract

Objectives: We conducted a retrospective study to investigate the effectiveness of angiotensin receptor blockers (ARBs) in preventing moderate-to-severe cerebral vasospasm, which may influence patient outcomes in cases of subarachnoid hemorrhage resulting from aneurysmal rupture. Methods: Between 2016 and 2020, we treated 210 patients with aneurysmal subarachnoid hemorrhage (aSAH) caused by a ruptured cerebral aneurysm. We obtained the clinical and radiological characteristics of patients through medical records and divided them into two groups: those who were administered ARBs (ARB group) and those who were not (no-ARB group). Results: A total of 181 patients aged 19 years or older with aSAH, without vascular abnormalities (including vascular malformations and moyamoya disease), were enrolled in this study. The age of the enrolled patients was 59.01 ± 12.98 (mean ± standard deviation), and the sex ratio of males to females was 66:115, with a higher proportion of females. The ARB group had 29 and the no-ARB group had 152 participants. The overall incidence of moderate-to-severe vasospasm was 33.7%. The incidence of moderate-to-severe vasospasm in each group was 13.8% (4 patients) and 37.5% (57 patients), respectively. The Fisher grade (III–IV) [odds ratio (OR) of 2.732 (95% confidence interval [CI]: 1.343–5.560; p = 0.006)] independently increases the risk of moderate-to-severe vasospasm, while older age [OR = 0.963; 95% CI: 0.938–0.989; p = 0.006] and ARB administration [OR = 0.246; 95% CI: 0.079–0.771; p = 0.016] independently decrease this risk. Conclusions: Despite the potential adverse impacts associated with hypotension, the administration of ARBs may provide therapeutic benefits in preventing moderate-to-severe vasospasm. A multicenter randomized double-blind controlled trial is needed to further investigate the efficacy and safety of ARBs in preventing moderate-to-severe vasospasm in aSAH patients who have undergone interventions and are experiencing acute hypertension.