Prior use of angiotensin-converting enzyme inhibitors does not affect outcome in patients with intracerebral hemorrhage

Background and objectives: Angiotensin-converting enzyme inhibitors (ACEI) exert protective effects in patients with stroke but their effects remain unknown in patients with intracerebral hemorrhage (ICH). Methods: We recruited consecutive patients with acute ICH and analysed pre-admission demographic variables and drug therapy as well as clinical and radiological parameters. Functional and neurological outcomes were determined with the modified Rankin score (mRS) and the NIH Stroke Scale (NIHSS) score administered 90 days after ICH. Results: Three hundred and ninety-nine patients were included over 6 years with a mortality rate of 47.3%. Before ICH, 130 patients (32.6%) used ACEI. ACEI-treated patients more often had vascular co-morbidities and were more frequently treated with anti-platelets. Admission NIHSS scores were significantly higher in ACEI-treated patients but 90 days NIHSS scores were not. Improvement from baseline NIHSS scores was significantly larger in ACEI-treated patients. Pre-ICH use of ACEI was not associated with lower mortality or better functional outcome on univariate analysis. On multivariable logistic regression analysis, controlling for possible confounding variables, ACEI use was not associated with increased chances for good outcome and failed to show an influence on mortality. Discussion: In conclusion, our study does not support a possible neuroprotective effect for ACEI use prior to the occurrence of ICH.