Spontaneous Elevation of Blood Pressure After SAH: An Epiphenomenon of Disease Severity and Demand, But Not a Surrogate for Outcome?

  • F. Teping
  • W. Albanna
  • H. Clusmann
  • H. Schulze-Steinen
  • M. Mueller
  • A. Hoellig
  • G. A. Schubert
Original Article



Spontaneous blood pressure increase is frequently observed after aneurysmal subarachnoid hemorrhage (aSAH). These episodes of spontaneous blood pressure alterations are usually tolerated under the assumption of an endogenous response to maintain cerebral perfusion. The relevance of blood pressure variability and its relationship to disease severity and outcome, however, remain obscure.


A total of 115 consecutive patients with aSAH were included for this retrospective analysis of a continuously collected data pool. Demographics, initial clinical severity of aSAH (HH°, mFS), treatment modality, clinical course, and outcome (development of DCI, cerebral infarction, and GOS after 3 months) were recorded. Hemodynamic information—recorded automatically with a frequency of 1/15 min—was analyzed for spontaneous blood pressure increase (SBI) and endogenous persistent hypertension (EPH) after exclusion of iatrogenic factors and relevant co-medication. Subgroup analysis included stratification for day 0–3, 4–14, and 14–21.


SBI and EPH incidence varied from 17 to 84% depending on detection threshold (15–35 mmHg) and time period under scrutiny. Incidence of blood pressure increase correlated with disease severity upon admission (p < 0.05), but the anticipated association with outcome was not observed. SBI and EPH were more likely to occur between day 4 and 14 (p < 0.001), but only early occurrence (day 0–3) was associated with higher incidence of DCI (p < 0.05). Persistent blood pressure elevation between day 4 and 21 was associated with fewer DCI. However, no influence of spontaneous upregulation on clinical outcome after three months was observed.


Spontaneous hemodynamic upregulation is a frequent phenomenon after aSAH. Our data support the hypothesis that spontaneous blood pressure alterations reflect an endogenous, demand-driven response correlating with disease severity. Early alterations may indicate an aggravated clinical course, while later upregulation in particular—if permitted—does not translate into a higher risk of unfavorable outcome.


Subarachnoid hemorrhage (SAH) Spontaneous upregulation Spontaneous hypertension Cerebral vasospasm Permissive hypertension Autoregulation 


Authors’ contributions

GAS and FT involved in the conception and design. FT and WA contributed to the acquisition of data. FT processed the data. FT, GAS, and WA involved in the analysis and interpretation of data. FT drafted the article and involved in illustrations and statistical analysis. All authors critically revised the article and reviewed the submitted version of the manuscript. FT approved the final version of the manuscript on behalf of all authors. GAS performed study supervision.


This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2018

Authors and Affiliations

  • F. Teping
    • 1
  • W. Albanna
    • 1
  • H. Clusmann
    • 1
  • H. Schulze-Steinen
    • 2
  • M. Mueller
    • 3
  • A. Hoellig
    • 1
  • G. A. Schubert
    • 1
  1. 1.Department of NeurosurgeryRWTH Aachen UniversityAachenGermany
  2. 2.Department of Operative Intensive Care and Intermediate CareRWTH Aachen UniversityAachenGermany
  3. 3.Department of Diagnostic and Interventional NeuroradiologyRWTH Aachen UniversityAachenGermany

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