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Association Between Regular Blood Pressure Monitoring and the Risk of Intracranial Aneurysm Rupture: a Multicenter Retrospective Study with Propensity Score Matching

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Abstract

Although hypertension is a known risk factor for intracranial aneurysm rupture, the benefit of the management of blood pressure in reducing the rupture risk of intracranial aneurysms remains largely unknown, especially for regular blood pressure monitoring. We conducted a retrospective analysis of a prospectively maintained database of 3965 patients with saccular intracranial aneurysms from 20 medical centers in China. The patients were divided into the non-hypertensive group and hypertensive group. Propensity score matching was applied to identify a cohort of patients with similar baseline characteristics. Univariable and multivariable logistic regression analyses were performed to determine the association between intracranial aneurysm rupture and the management of blood pressure. After matching, hypertension was significantly associated with an increased rupture risk of intracranial aneurysms (OR = 2.559, 95%CI = 2.161–3.030, P = 0.000). For the management of blood pressure, controlled hypertension (OR = 1.803, 95%CI = 1.409–2.307, P = 0.000), uncontrolled hypertension (OR = 2.178, 95%CI = 1.756–2.700, P = 0.000), and hypertension without regular blood pressure monitoring (OR = 5.000, 95%CI = 3.823–6.540, P = 0.000) were all significantly associated with a higher rupture risk compared with the absence of hypertension. Moreover, hypertension without regular blood pressure monitoring was associated with a higher rupture risk compared with either controlled hypertension (OR = 3.807, 95%CI = 2.687–5.395, P = 0.000) or hypertension with regular blood pressure monitoring (including controlled and uncontrolled hypertension) (OR = 2.893, 95%CI = 2.319–3.609, P = 0.000). The absence of regular blood pressure monitoring was significantly associated with an increased risk of intracranial aneurysm rupture, emphasizing the importance of implementation of regular blood pressure monitoring in hypertensive patients with intracranial aneurysms.

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Data Availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We are grateful to the investigators from the 20 tertiary academic medical centers who participated in the National Research and Development Project of Intracranial Aneurysms for their prospectively comprehensive collection of patients’ data. Meanwhile, we are also grateful to Dr. Zaixing Shi, the assistant professor of statistics from the Public Health School of Xiamen University, for his professional suggestions regarding the statistical method.

Funding

This study was funded by the National Research and Development Project of Key Chronic Diseases (Grant No.2016YFC1300703), the Medical Project of Xiamen Municipal Bureau of Science and Technology (Grant No.3502Z20214ZD1013), and the Fujian Provincial Natural Science Foundation of China (Grant No. 2021J011367).

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Author notes

  1. Ping Zhong and Zhiwen Lu contributed equally to this work.

Authors and Affiliations

  1. BE and Phase I Clinical Trial Center, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China

    Ping Zhong

  2. Neurovascular Center, Changhai Hospital, Second Military Medical University, Changhai Road 168, Shanghai, 200433, China

    Zhiwen Lu, Jianmin Liu & Qinghai Huang

  3. Neurovascular Center, Henan Provincial People’s Hospital, Zhengzhou, China

    Tianxiao Li

  4. Department of Neurosurgery, Second Affiliated Hospital of Soochow University, Suzhou, China

    Qing Lan

  5. Department of Neurosurgery, Xiamen Key Laboratory of Brain Center, the First Affiliated Hospital of Xiamen University, Xiamen, China

    Zhanxiang Wang

  6. Department of Neuroscience, Institute of Neurosurgery, School of Medicine, Xiamen University, Xiamen, China

    Zhanxiang Wang

  7. Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, No. 55 Zhenhai Road, Xiamen, 361003, Fujian, China

    Sifang Chen

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Contributions

ZP and LZ collected the data and performed the research. Data were analyzed by ZP and LZ. ZP drafted the manuscript. CS and HQ conceived and designed the research. LJ, LT, LQ, WZ, and HQ initiated and organized this study. All authors reviewed and edited the manuscript and approved the final version of the manuscript.

Corresponding authors

Correspondence to Sifang Chen or Qinghai Huang.

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Ethics Statement

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study is one of the research contents of the National Research and Development Project of Intracranial Aneurysms, in which the ethical approval had been approved by the local institutional review board.

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Zhong, P., Lu, Z., Li, T. et al. Association Between Regular Blood Pressure Monitoring and the Risk of Intracranial Aneurysm Rupture: a Multicenter Retrospective Study with Propensity Score Matching. Transl. Stroke Res. 13, 983–994 (2022). https://doi.org/10.1007/s12975-022-01006-7

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  • DOI: https://doi.org/10.1007/s12975-022-01006-7

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