Angiotensin receptor blockers (ARBs) reduce the risk of developing epilepsy in patients with ischemic stroke and hypertension

Purpose: Stroke is the most common cause of seizures in patients older than 60 years. About 10–30 % of new epilepsy diagnoses in elderly patients are associated with a brain ischemic event. Hypertension is a major risk factor for epilepsy and stroke, and 2 % of patients with epilepsy have hypertension. According to the European Society of Cardiology guidelines, Angiotensin-Converting Enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) are first-line hypertension treatment. ACEi and ARBs promote a protective effect against the development of seizures in the general population. However, no data are available about their possible preventive role in post-stroke epilepsy (PSE). In this study, we evaluated the relationship between different antihypertensive regimens and the risk of developing post-stroke epilepsy (PSE). Methods: In this retrospective, observational study, we selected and evaluated data relative to patients with hypertension and a diagnosis of ischemic stroke (as confirmed by clinical and neuroimaging evaluations and who accessed our neurology ward between January 2016 and January 2022). All participants were followed up for a median period of 24 months. The PSE diagnosis was made according to the ILAE criteria. We excluded patients with acute symptomatic seizures. The details of the antihypertensive treatments, demographics, and clinical and neuroradiological data were analyzed. Results: 528 patients (mean age: 71.37 ± 13.64, 302 men, 57.19 %) were enrolled. Thirty-eight (7.2 %) patients developed PSE. Anterior Cerebral Artery involvement (p = 0.05) and cortico-subcortical lesions (p = 0.001) were associated with a higher risk of PSE. A lower risk of PSE was observed in patients treated with ARBs, both before (p = 0.009) and after (p = 0.02) the stroke event. PSE incidence was higher in patients receiving Calcium Channel blockers (CCBs) (p = 0.019) and Beta-blockers (BBs) (p = 0.008) before the stroke event as well as BBS after the stroke event (p = 0.003). No differences were observed for ACEi if administered previous (p = 0.42) or after (p = 0.48) the stroke event. Conclusions: ARBs appear to offer a protective role against epilepsy development in patients with hypertension and stroke. These findings suggest that ARBs could be considered a promising target for future prospective studies evaluating PSE prevention in stroke patients.