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Liu H, Zuo H, Johanna O, Zhao R, Yang P, Chen W, Li Q, Lin X, Zhou Y, Liu J. Genetically determined blood pressure, antihypertensive medications, and risk of intracranial aneurysms and aneurysmal subarachnoid hemorrhage: A Mendelian randomization study. Eur Stroke J 2024; 9:244-250. [PMID: 37800876 PMCID: PMC10916827 DOI: 10.1177/23969873231204420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/13/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Observational studies suggest that different classes of antihypertensive drugs may have different effects on the occurrence of intracranial aneurysms (IA) and subarachnoid hemorrhage (SAH). However, the reported results in previous studies are inconsistent, and randomized data are absent. We performed a two-sample Mendelian randomization (MR) analysis to study the causal effects of genetically determined blood pressure (BP) and genetic proxies for antihypertensive drug classes on the risk of IA and SAH. MATERIALS AND METHODS Genetic instruments and outcome data were obtained from independent genome-wide association studies (GWAS) or published data, which were exclusively restricted to European ancestry. Causal relationships were identified using inverse-variance weighted MR analyses and a series of statistical sensitivity analyses. The FinnGen consortium was used for repeated analysis to verify results obtained from the above GWAS. RESULTS Two-sample MR analysis showed that genetically determined Systolic BP, Dystolic BP, and Pulse Pressure were related to a higher risk of IA and SAH. Based on identified single nucleotide polymorphisms (SNPs) that influence the effect of calcium channel blockers (CCB, 42 SNPs), beta-blockers (BB, 8 SNPs), angiotensin-converting enzyme inhibitors (ACEI, 2 SNPs), angiotensin receptor blockers (ARB, 1 SNPs), and thiazides (5 SNPs), genetically determined effect of CCBs was associated with a higher risk of IA (OR, 1.07 [95% CI, 1.03-1.10], p = 5.02 × 10-5) and SAH (OR, 1.06 [95% CI, 1.03-1.09], p = 1.84 × 10-3). No associations were found between other antihypertensive drugs and the risk of IA or SAH. The effect of CCBs on SAH was confirmed in FinnGenconsortium samples (OR, 1.04 [95% CI, 1.00-1.08], p = 0.042). DISCUSSION AND CONCLUSION This MR analysis supports the role of elevated blood pressure in the occurrence of intracranial aneurysms and subarachnoid hemorrhage. However, genetic proxies for calcium channel blockers were associated with an increased risk of intracranial aneurysms and subarachnoid hemorrhage. Further studies are required to confirm these findings and investigate the underlying mechanisms.
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Affiliation(s)
- Hanchen Liu
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Huiqin Zuo
- Huamu Community Center of Pudong, Shanghai, China
| | - Ospel Johanna
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Rui Zhao
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Pengfei Yang
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | | | - Qiang Li
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Xiaolei Lin
- School of Data Science, Fudan University, Shanghai, China
| | - Yu Zhou
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Jianmin Liu
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
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Dinger TF, Darkwah Oppong M, Park C, Said M, Chihi M, Rauschenbach L, Gembruch O, Deuschl C, Wrede KH, Lenz V, Kleinschnitz C, Forsting M, Sure U, Jabbarli R. Development of multiple intracranial aneurysms: beyond the common risk factors. J Neurosurg 2022; 137:1056-1063. [PMID: 35120308 DOI: 10.3171/2021.11.jns212325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 11/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The prevalence of multiple intracranial aneurysms (MIAs) has increased over the last decades. Because MIAs have been identified as an independent risk factor for formation, growth, and rupture of intracranial aneurysms (IAs), a more profound understanding of the underlying pathophysiology of MIAs is needed. Therefore, the authors' extensive institutional aneurysm database was analyzed to elucidate differences between patients with a single IA (SIA) and those with MIAs. METHODS A total of 2446 patients seen with or for IAs at the University Hospital of Essen, Essen, Germany, from January 2003 to June 2016 were included in this retrospective cohort study and were separated into MIA and SIA subgroups. Patient data were screened for sociodemographic and radiographic parameters, preexisting medical conditions, and results of blood examinations. These parameters were analyzed for their correlations with MIAs and absolute number of IAs. RESULTS MIAs were identified in 853 (34.9%) patients. In multivariable analysis, MIAs were independently associated with female sex (p = 0.001), arterial hypertension (p = 0.023), tobacco abuse (p = 0.009), AB blood group (p = 0.010), and increased admission values for C-reactive protein (p = 0.006), mean corpuscular volume (p = 0.009), and total serum protein (p = 0.034), but not with diagnostic modality (3D vs 2D digital subtraction angiography, p = 0.912). Absolute number of IAs was independently associated with female sex (p < 0.001), arterial hypertension (p = 0.014), familial predisposition to IA (p = 0.015), tobacco consumption (p = 0.025), increased mean corpuscular volume (p = 0.002), and high platelet count (p = 0.007). CONCLUSIONS In this sizable consecutive series of patients with IAs, the authors confirmed the impact of common IA risk factors on the genesis of MIAs. In addition, specific hemorheological and hemocytological features may also contribute to the development of MIAs.
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Affiliation(s)
- Thiemo F Dinger
- 1Department of Neurosurgery and Spine Surgery, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Marvin Darkwah Oppong
- 1Department of Neurosurgery and Spine Surgery, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Chikadibia Park
- 1Department of Neurosurgery and Spine Surgery, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Maryam Said
- 1Department of Neurosurgery and Spine Surgery, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Mehdi Chihi
- 1Department of Neurosurgery and Spine Surgery, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Laurèl Rauschenbach
- 1Department of Neurosurgery and Spine Surgery, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Oliver Gembruch
- 1Department of Neurosurgery and Spine Surgery, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Cornelius Deuschl
- 2Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Karsten H Wrede
- 1Department of Neurosurgery and Spine Surgery, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Veronika Lenz
- 3Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; and
| | - Christoph Kleinschnitz
- 4Department of Neurology and Center for Translational Neuroscience and Behavioral Science (C-TNBS), University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Michael Forsting
- 2Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Ulrich Sure
- 1Department of Neurosurgery and Spine Surgery, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Ramazan Jabbarli
- 1Department of Neurosurgery and Spine Surgery, University Hospital, University of Duisburg-Essen, Essen, Germany
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