Existing high blood pressure medications could prevent epilepsy, study finds

A class of drugs already on the market to lower blood pressure appears to reduce the risk of developing epilepsy in adults, Stanford Medicine researchers and their colleagues have found. This finding resulted from an analysis of the medical records of more than 2 million Americans taking blood pressure medications.

The study, published June 17 in JAMA Neurologysuggests that the drugs, called angiotensin receptor blockers, could prevent epilepsy in people most at risk of developing the disease, including older people who have had a stroke.

“This is incredibly exciting because we currently have no drugs to prevent epilepsy,” said Kimford Meador, MD, professor of neurology and neuroscience and senior author of the paper. “I hope these initial results will lead to randomized clinical trials.”

Preventing seizures after a stroke

Although epilepsy is often diagnosed during childhood, more than 1% of people over the age of 65 are diagnosed with the recurrent seizures that characterize this disorder. These seizures can temporarily disrupt brain function and cause a range of symptoms.

In older adults, the most common risk factor for developing epilepsy is stroke; about 10% of stroke survivors experience seizures within five years. Vascular disease and chronic high blood pressure, even in the absence of a stroke, also increase the risk of epilepsy.

“It can be a very debilitating disorder, and it’s much more common in older adults than people think,” said Meador, a member of the Wu Tsai Neuroscience Institute.

Although antiepileptic medications can be used to control epilepsy after diagnosis, no medications are approved to prevent epilepsy in people at high risk of developing the condition.

However, over the past decade, studies have suggested that a type of blood pressure medication may help soothe attacks due to their ability to dampen inflammation. This aspect would be particularly suitable for preventing seizures following a stroke or head trauma, as both cause brain inflammation that can trigger epilepsy.

In 2022, a study of more than 160,000 people in Germany found that people taking angiotensin receptor blockers – one of multiple classes of drugs prescribed to treat high blood pressure – had a reduced risk of develop epilepsy. The medications block certain hormone receptors, leading to lower blood pressure and less inflammation in blood vessels and other organs, including the brain.

“These German results echoed what had been found in animal studies and looked very promising, but I felt it was important to replicate this analysis using data from people in the United States,” said Meador.

A larger, broader data set

For the new study, Meador and his colleagues at the University of Rhode Island turned to a national database that includes information on the health care claims of more than 20 million Americans enrolled either in plans commercial health insurance, or Medicare, a more racially diverse group than that in the United States. the German study. They focused their analysis on 2.2 million adults who had been diagnosed with high blood pressure, who had been prescribed at least one blood pressure medication, and who did not already have epilepsy.

Overall, people taking angiotensin receptor blockers had a 20% to 30% lower risk of developing epilepsy between 2010 and 2017 compared to people taking other blood pressure medications. This difference held true even when stroke patients were removed from the analysis, suggesting that the lower epilepsy rates were not solely the result of decreased stroke risk. cerebrovascular.

“What we did was replicate what was found in Germany, but in a larger and completely different population,” Meador said. “It really increases the signal strength and tells us there’s something real going on here.”

The data also indicated that a particular angiotensin receptor blocker, losartan, had the most powerful effect on reducing the risk of epilepsy, but the researchers said more work was needed to confirm this. .

Towards clinical trials

All blood pressure medications are likely to have an impact on reducing the risk of epilepsy because high blood pressure is a contributing factor to epilepsy. Keeping blood pressure under control through any combination of antihypertensive medications and lifestyle factors can therefore reduce the risk of developing epilepsy, Meador said.

However, new research suggests that angiotensin receptor blockers may be more beneficial than other antihypertensive medications in allowing patients to reduce the risk of epilepsy. In the new study, about 14% of people taking blood pressure medication were taking angiotensin receptor blockers, while most were taking other classes of medications to control their blood pressure, including beta blockers, calcium antagonists and angiotensin-converting enzyme inhibitors.

“This could open a new chapter in the history of preventive medicine,” Meador said. “There are so many people suffering from stroke or high blood pressure; knowing that this class of drugs not only lowers blood pressure but also helps reduce the risk of epilepsy could change the way we treat them .”

However, Meador added, randomized clinical trials are needed to prove the association between angiotensin receptor blockers and reducing the risk of epilepsy before treatment guidelines change.

Researchers from Brown University also participated in the research.