1. Amongst a cohort of individuals with arterial hypertension, those who were taking angiotensin receptor blocker antihypertensives had the lowest incidence of epilepsy.

2. The highest incidence of epilepsy amongst patients with medication-controlled arterial hypertension was in those taking calcium channel blockers or beta blockers.

Level of Evidence Rating: 2 (Good)

Study Rundown: Epilepsy is a chronic neurological condition characterized by the tendency to experience recurrent seizures. It is a chronic disease which may require lifelong medical therapy and can be refractory to treatment in some cases. In preclinical studies, it has been demonstrated that certain antihypertensive medications may be neuroprotective through modulation of the albumin-induced transforming growth factor cascade pathway in central neurons. Therefore, this study’s purpose was to retrospectively assess the association between epilepsy diagnoses and the treatment of hypertension with various pharmaceutical classes.

In total, 168 612 patients were included, with 42 153 in each subgroup of antihypertensive medication use. The incidence of epilepsy was lowest amongst patients taking ARBs at 1-, 3- and 5-year time points and highest amongst those taking BBs and CCBs. ARBs were significantly reduced with a lower risk of epilepsy; in the analysis of individual drug effects, losartan was significantly protective against epilepsy compared to beta blockers. There was no significant difference in epilepsy incidence based on hypertension severity.

The present study by Doege et al. demonstrated that hypertension management with ARBs may be associated with a decreased risk of epilepsy, particularly in comparison with other classes of antihypertensive, including beta blockers and calcium channel blockers. A strength of this study includes the large sample size and matching of cohorts based on demographics and known risk factors for the outcome. A primary drawback of this work was its retrospective nature, making it difficult to control for confounding. The findings reported here should be studied in a prospective setting to assess their applicability to clinical practice better.

Source: physiciansweekly.com, Gursharan Sohi