Blood Pressure Medications Don’t Prevent Delirium in ICU Patients: Study

A recent study reveals that common blood pressure medications don’t provide protection against delirium for patients in intensive care units (ICUs). The research, carried out by scientists from Regenstrief Institute and the universities of South Carolina and Indiana, specifically looked at the effects of ACE inhibitors and angiotensin receptor blockers, drugs thought to have neuroprotective qualities.

Delirium, a severe and sudden brain failure, affects around seven million hospitalized patients in the U.S. every year. Its consequences can be dire, leading to a longer hospital and ICU stay, a higher chance of needing mechanical ventilation, and increased risks of long-term cognitive damage, new nursing home placement, and death. The more severe and lengthy the delirium, the worse the long-term impacts on mental and physical well-being.

The researchers were keen to investigate whether these medications could play a role in preventing delirium, especially as chronic high blood pressure is one of the risk factors for ICU-acquired delirium.

“We have been looking at potential ways to decrease delirium severity and duration. In this study we looked at ACE inhibitors and angiotensin receptor blockers because these drugs stabilize blood pressure and are thought to have neuroprotective qualities,” explains Dr. Babar Khan, a senior author of the study, in a statement. However, he added, “Unfortunately, we did not find lower prevalence of delirium among patients prescribed these medications prior to ICU admission, compared to patients who had not taken them.”

The study, which reviewed the electronic health records of 4,791 racially diverse patients, found that taking these blood pressure medications for at least six months prior to ICU admission didn’t provide any protective benefit or enhance brain resilience against delirium.

The findings align with previous research. In 2018, Dr. Khan co-authored a study published in the New England Journal of Medicine, revealing that commonly prescribed antipsychotic drugs did not alter the duration of delirium either.

The team is not giving up on the quest to find ways to prevent or manage delirium. Study authors are now working with the Mayo Clinic on a multi-site study exploring whether a specially designed music intervention might reduce the likelihood of delirium in older adult ICU patients on mechanical ventilation and even improve post-ICU brain health.

“This study of blood pressure medications represents our ongoing efforts to understand the role of vascular risk factors in delirium,” adds study co-author Dr. Sikandar Khan. “Our long-term goal is to understand how different biological processes in aging, such as blood pressure, inflammation etc., interact, eventually leading to delirium and then ultimately dementia.”

The research is published in the Journal of the American Geriatrics Society.

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