Association of Blood Pressure Parameters in Unsecured Aneurysmal Subarachnoid Hemorrhage and Outcomes
Ariyaporn Haripottawekul1, Saba Paracha1, Deena Haque1, Elijah Persad-Paisley1, Alizeh Shamshad1, Aiden Meyer1, Michael Reznik2, Karen Furie3, Shadi Yaghi1, Ali Mahta1
1Brown University, 2Rhode Island Hospital, 3RIH/Alpert Medical School of Brown Univ
Objective:
To investigate the association between BP parameters, MAP, rebleeding events, and outcomes for aSAH patients.
Background:
Elevated systolic blood pressure (SBP) has been linked to pre-procedural rebleeding risk and poor outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). However, the relationship between blood pressure parameters including mean arterial pressure (MAP) with rebleeding prior to and after aneurysm securement remains unclear. This study seeks to determine the association between BP parameters and rebleeding events and outcomes in patients with aSAH.
Design/Methods:
We performed a retrospective analysis of consecutive patients with aSAH admitted to an academic center between 2016-2022. BP values were recorded hourly from admission. Per our institutional protocol, the SBP target is <140 mmHg for all unsecured aSAH aneurysms. Rebleeding was defined as radiographic worsening of hemorrhage prior to or immediately following aneurysm securement. Binary regression analysis was used to determine the association of maximum recorded BP with rebleeding and poor functional outcome (modified Rankin Scale [mRS] 4–6 at 3 months post-discharge).
Results:
The cohort included 325 patients (mean age 57 years [SD 13.4], 61% female, 87% received endovascular treatments, 13% surgical clipping). Two or more consecutive SBP values >140 were seen in 41% and >160 in 15% of patients. Rebleeding prior to or during securing aneurysms including intra-procedural bleeding occurred in 48 patients (15%). There was no association between either maximum recorded SBP (175 mmHg [36.3] vs. 167 [33.4], p=0.12) or MAP (124 mmHg [25.5] vs. 117.9 [22.5], p=0.08) and rebleeding. However, only maximum recorded MAP pre-angiogram was associated with poor outcome (OR 1.014 for 1 mmHg increase in MAP, 95% CI: 1.004–1.03, p=0.006).
Conclusions:
Elevated MAP peri-securement of a ruptured cerebral aneurysm can be associated with poor outcome. Multicenter prospective studies should further examine the association between MAP cut offs and outcomes to consider modifying current guidelines.