{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:41:04Z","timestamp":1753890064166,"version":"3.41.2"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["SVIN"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Local angiotensin activity is thought to play a critical role in arterial wall homeostasis and remodeling, and impaired arterial wall integrity contributes to the pathogenesis of subarachnoid hemorrhage (SAH). Here we aimed to assess the association between pharmacologic inhibition of angiotensin\u2010converting enzyme and subsequent nontraumatic SAH.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods<\/jats:title>\n            <jats:p xml:lang=\"en\">In a retrospective cohort study based on Optum's Clinformatics Datamart deidentified database records (2000\u20132021), we included all subjects with a history of hypertension. We collected medication history, and the exposure of interest was the use of an angiotensin\u2010converting enzyme inhibitor or angiotensin receptor blocker (ACEI\/ARB). The primary outcome was the subsequent development of nontraumatic SAH. Cox proportional hazard regression models were used to compare the time to SAH by type of antihypertensive treatment.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              A total of 7.5 million patients with hypertension were assessed. Patients on ACEI\/ARBs with or without other antihypertensives (n = 4.8 million, follow\u2010up: 6.3 years) had lower rates of SAH compared with those on alternative antihypertensive regimens (n = 1.3 million, follow\u2010up: 5.7 years) (hazard ratio [HR]:0.94 [0.91\u20130.97];\n              <jats:italic>P<\/jats:italic>\n              &lt;0.0001), as well as compared with those on no antihypertensive medications (n = 1.4 million, follow\u2010up: 5.3 years) (HR:0.94 [0.91\u20130.97];\n              <jats:italic>P<\/jats:italic>\n              = 0.0002). However, antihypertensive medications other than ACEI\/ARBs were not associated with SAH risk compared with treatment by no antihypertensives (HR:1.00 [0.97\u20131.04];\n              <jats:italic>P<\/jats:italic>\n              = 0.83). Among 8034 patients with known unruptured intracerebral aneurysms, no difference in SAH with ACEI\/ARBs was observed compared to alternative antihypertensive regimens (HR:1.04 [0.95\u20131.13]) or no antihypertensive therapy (HR:1.06 [0.97\u20131.16]). Uninterrupted ACEI\/ARBs use for \u22653 years reduced the risk of SAH by 23%, compared with treatment by only other hypertensives (HR:0.71 [0.68\u20130.74];\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p xml:lang=\"en\">Treatment of hypertension with ACEI\/ARBs was associated with a lower risk of SAH than other types of antihypertensive agents, particularly with longer courses of therapy.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/svin.124.001482","type":"journal-article","created":{"date-parts":[[2024,12,9]],"date-time":"2024-12-09T06:25:12Z","timestamp":1733725512000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Angiotensin Inhibition Reduces the Risk of Subarachnoid Hemorrhage in Patients With Hypertension"],"prefix":"10.1161","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5812-2359","authenticated-orcid":false,"given":"Mohammad Hossein","family":"Abbasi","sequence":"first","affiliation":[{"name":"Department of Neurology Perelman School of Medicine University of Pennsylvania Philadelphia PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colleen M.","family":"Brensinger","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Biostatistics Perelman School of Medicine University of Pennsylvania Philadelphia PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily K.","family":"Acton","sequence":"additional","affiliation":[{"name":"Department of Neurology Perelman School of Medicine University of Pennsylvania Philadelphia PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher G.","family":"Favilla","sequence":"additional","affiliation":[{"name":"Department of Neurology Perelman School of Medicine University of Pennsylvania Philadelphia PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan\u2010Karl","family":"Burkhardt","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Perelman School of Medicine University of Pennsylvania Philadelphia PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott E.","family":"Kasner","sequence":"additional","affiliation":[{"name":"Department of Neurology Perelman School of Medicine University of Pennsylvania Philadelphia PA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jphs.2021.10.007"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2005-923537"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.3171\/2016.9.JNS161593"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000190838.02954.e8"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-013-1907-6"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surneu.2006.06.063"},{"key":"e_1_3_2_8_2","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1161\/01.CIR.0000087339.31094.3C","article-title":"Role of a decreased expression of the local renin\u2010angiotensin system in the etiology of cerebral aneurysms","volume":"108","author":"Ohkuma H","year":"2003","unstructured":"Ohkuma H, Suzuki S, Fujita S, Nakamura W. Role of a decreased expression of the local renin\u2010angiotensin system in the etiology of cerebral aneurysms. Circulation. 2003;108:785\u2010787.","journal-title":"Circulation"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(76)90888-3"},{"key":"e_1_3_2_10_2","doi-asserted-by":"crossref","first-page":"977","DOI":"10.2165\/00003495-200262070-00001","article-title":"Angiotensin converting enzyme gene insertion\/deletion polymorphism and cardiovascular disease: therapeutic implications","volume":"62","author":"Niu T","year":"2002","unstructured":"Niu T, Chen X, Xu X. Angiotensin converting enzyme gene insertion\/deletion polymorphism and cardiovascular disease: therapeutic implications. Drugs. 2002;62:977\u2010993.","journal-title":"Drugs"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-19-0955"},{"key":"e_1_3_2_12_2","doi-asserted-by":"crossref","first-page":"230","DOI":"10.3892\/mmr.2021.11869","article-title":"Involvement of TLR2\/4\u2011MyD88\u2011NF\u2011\u03baB signaling pathway in the pathogenesis of intracranial aneurysm","volume":"23","author":"Zhang X","year":"2021","unstructured":"Zhang X, Wan Y, Feng J, Li M, Jiang Z. Involvement of TLR2\/4\u2011MyD88\u2011NF\u2011\u03baB signaling pathway in the pathogenesis of intracranial aneurysm. Mol Med Rep. 2021;23:230.","journal-title":"Mol Med Rep"},{"key":"e_1_3_2_13_2","first-page":"353","article-title":"Role of angiotensin II type 1 receptor in cerebral aneurysm formation in rats","volume":"24","author":"Aoki T","year":"2009","unstructured":"Aoki T, Nishimura M, Kataoka H, Ishibashi R, Miyake T, Takagi Y, Morishita R, Hashimoto N. 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Stroke. 2004;35:1594\u20101597.","journal-title":"Stroke"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1080\/01616412.1998.11740571"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1136\/jmg.37.7.498"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2011.02.025"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0111952"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000032240.28636.BD"},{"key":"e_1_3_2_20_2","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1038\/jcbfm.2015.30","article-title":"Angiotensin\u2010(1\u20107) protects against the development of aneurysmal subarachnoid hemorrhage in mice","volume":"35","author":"Shimada K","year":"2015","unstructured":"Shimada K, Furukawa H, Wada K, Wei Y, Tada Y, Kuwabara A, Shikata F, Kanematsu Y, Lawton MT, Kitazato KT, et\u00a0al. 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