2025 American Academy of Neurology Abstract Website

Objective:

Conduct a systematic review analyzing the safety and efficacy of induced hypertension in the treatment of delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage.

Background:

Induced hypertension (IH) is a mainstay of intervention following aneurysmal subarachnoid hemorrhage (aSAH) aimed at treating delayed cerebral ischemia (DCI) and preventing cerebral infarction. While IH might be effective at reversing acute neurological worsening due to DCI, evidence is lacking regarding long-term benefit, functional outcomes, and adverse events.

Design/Methods:

We searched seven databases for studies using vasopressors in aSAH from inception through April 8, 2024. Studies investigating the use of IH as either treatment or prevention of vasospasm in adults with aSAH were included.

Results:

The search identified 10,272 articles, of which 149 were eligible for full-text screening, and 23 studies were ultimately included based on our preset criteria. For the 1,555 patients treated with IH, the most common vasopressor used was norepinephrine, and blood pressure targets ranged from MAP: 100-130mmHg and SBP: 160-230mmHg. Six studies included non-IH controls (n=289, 15.7%), only one of which reported significant improvement in DCI-related infarction (aHR 0.59, CI=0.35-0.99). The one RCT intervening with IH was halted due to ineffectiveness and slow recruitment. Other outcomes for IH patients included hospital mortality (n=62 of 390, 15.9%), radiographic cerebral infarctions from DCI (n=278 of 1116, 24.9%), and mRS score <3 (n=130 of 353, 36.8%). Adverse events were reported in 18 studies (n=1125), the most common being pulmonary edema (n=70, 20%).

Conclusions:

There is some evidence that IH is similar in outcomes to treatment without IH, though analysis is restricted by absence of conclusive RCTs and lack of comparative cohorts in most observational studies. Variability in blood pressure targets, vasopressor choice, and patient heterogeneity limit interpretation of the available literature, necessitating more standardized approaches addressing long-term efficacy and safety outcomes when studying the effect of IH in aSAH.