Effect of premorbid hypertension control on outcome of patients with aneurysmal subarachnoid hemorrhage
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Hypertension is common in patients with aneurysmal subarachnoid hemorrhage (SAH). However, it is still unclear whether premorbid antihypertensive therapy can help to reduce the risk of severe aneurysmal bleeding. Therefore, this study aims to assess the effect of premorbid hypertension control on outcome of patients with aneurysmal SAH.
We retrospectively reviewed the clinical data of patients with intracranial aneurysms admitted to our institution from February 2012 to December 2017. Based on premorbid hypertension history and use of antihypertensive agents, all patients with aneurysmal SAH were divided into antihypertensive group and uncontrolled group. Patient characteristics, imaging features, clinical complication, and outcome were analyzed between the two groups.
A total of 348 patients with ruptured aneurysms were included in this study. Compared to those with premorbid controlled hypertension, patients with premorbid uncontrolled hypertension presented worse clinical grade, with more severe aneurysmal SAH and more frequent intracerebral hematoma. Patients receiving a treatment for ACEI type or ARB type of drugs in the antihypertensive group suffered from less amount of aneurysmal bleeding, while patients with grade 3 hypertension in the uncontrolled group suffered from more amount of aneurysmal bleeding. Patients with premorbid controlled hypertension had a lower incidence of rebleeding, hydrocephalus, and cerebral vasospasm, and had a lower rate of disability and mortality.
Premorbid hypertension control is associated with favorable clinical outcome of patients with aneurysmal SAH. Besides, the ACEI type or ARB type of antihypertensive agents is associated with the less amount of bleeding after aneurysm rupture.
KeywordsIntracranial aneurysm Subarachnoid hemorrhage Antihypertensive treatment Outcome
National Natural Science Foundation of China (No. 81671160; No. 81571159) and 13th Five-Year National Key Research Project of China (2016YFC1300800; 2016YFC1300804; 2016YFC1300805) provided financial support. The sponsor had no role in the design or conduct of this research.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (Chongqing Medical University First Affiliated Hospital) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
For this type of study, formal consent is not required.
- 1.Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, Hoh BL, Kirkness CJ, Naidech AM, Ogilvy CS, Patel AB, Thompson BG, Vespa P (2012) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 43:1711–1737CrossRefGoogle Scholar
- 6.De Marchis GM, Lantigua H, Schmidt JM, Lord AS, Velander AJ, Fernandez A, Falo MC, Agarwal S, Connolly ES Jr, Claassen J, Mayer SA (2014) Impact of premorbid hypertension on haemorrhage severity and aneurysm rebleeding risk after subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 85:56–59CrossRefGoogle Scholar
- 8.Lindgren A, Turner EB, Sillekens T, Meretoja A, Lee JM, Hemmen TM, Koivisto T, Alberts M, Lemmens R, Jääskeläinen JE, Vergouwen MDI, Rinkel GJE (2018) Outcome after clipping and coiling for aneurysmal subarachnoid hemorrhage in clinical practice in Europe, USA, and Australia. Neurosurgery. https://doi.org/10.1093/neuros/nyy223
- 9.Stranjalis G, Loufardaki M, Koutsarnakis C, Kalamatianos T (2016) Trends in the management and hospital outcome of spontaneous subarachnoid hemorrhage in the post-international subarachnoid aneurysm trial era in Greece: analysis of 719 patients during a 13-year period. World Neurosurg 88:327–332CrossRefGoogle Scholar
- 10.Zhao B, Tan X, Yang H, Li Z, Zheng K, Xiong Y, Zhong M (2016) Endovascular coiling versus surgical clipping for poor-grade ruptured intracranial aneurysms: postoperative complications and clinical outcome in a multicenter poor-grade aneurysm study. AJNR Am J Neuroradiol 37:873–878CrossRefGoogle Scholar
- 13.Tominari S, Morita A, Ishibashi T, Yamazaki T, Takao H, Murayama Y, Sonobe M, Yonekura M, Saito N, Shiokawa Y, Date I, Tominaga T, Nozaki K, Houkin K, Miyamoto S, Kirino T, Hashi K, Nakayama T (2015) Unruptured Cerebral Aneurysm Study Japan Investigators. Prediction model for 3-year rupture risk of unruptured cerebral aneurysms in Japanese patients. Ann Neurol 77:1050–1059CrossRefGoogle Scholar
- 19.Lindgren AE, Kurki MI, Riihinen A, Koivisto T, Ronkainen A, Rinne J, Hernesniemi J, Eriksson JG, Jääskeläinen JE, von und zu Fraunberg M (2014) Hypertension predisposes to the formation of saccular intracranial aneurysms in 467 unruptured and 1053 ruptured patients in Eastern Finland. Ann Med 46:169–176CrossRefGoogle Scholar
- 25.Griessenauer CJ, Tubbs RS, Foreman PM, Chua MH, Vyas NA, Lipsky RH, Lin M, Iyer R, Haridas R, Walters BC, Chaudry S, Malieva A, Wilkins S, Harrigan MR, Fisher WS 3rd, Shoja MM (2018) Association of renin-angiotensin system genetic polymorphisms and aneurysmal subarachnoid hemorrhage. J Neurosurg 128:86–93CrossRefGoogle Scholar