Preadmission Use of Angiotensin-converting Enzyme Inhibitor or Angiotensin II Receptor Blocker and Short-term Mortality in Spontaneous Intracerebral Hemorrhage

Introduction: Intracerebral Hemorrhage (ICH) features disproportionate lethality compared to other stroke types, as it accounts for just 10-15% of strokes yet over half the deaths. ICH results in 30-40% mortality within 30 days. Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) are first-line antihypertensives, with studies showing conflicting results regarding their influence on ICH outcomes.

Methods: One hundred patients were randomly selected from a database of spontaneous nontraumatic ICH between 2019 and 2022. Baseline demographics, comorbidities, and functional status were collected along with preadmission medications. Admission and follow-up data such as first blood pressure, ICH score, modified Rankin scale (baseline, admission, and 30-day follow-up), and radiological features were also collected. A logistic regression model was built to predict mortality by ACEI/ARB use. Statistical significance was set at p ≤ 0.05.

Results: 42 of 100 patients were using ACEI or ARB at least 2 weeks prior to admission. There were 22 deaths within 30 days, 7 of which were ACEI/ARB users. ACEI or ARB usage did not significantly predict mortality when controlling for gender, ICH score and risk factors of hypertension, coronary artery disease, dementia, and diabetes. ICH score did predict mortality (OR 2.4, 95% CI 1.4, 4.2, p < 0.01). Gender also influenced mortality with females being 6 times more likely to expire within 30 days than males (p < 0.01). In our sample, 10% of males and 41% of females expired.

Conclusion : Our preliminary findings suggest that ACEI/ARB usage prior to admission does not significantly reduce mortality within 30 days of insult. However, our models suggested that females have substantially higher mortality than males. Current literature shows conflicting findings for differences in mortality between ACEI/ARB usage, as well as between genders. Therefore, follow-up analyses with a larger sample size are needed.