Auswirkungen des initialen systolischen Blutdrucks auf frühe Komplikationen und klinische Ergebnisse bei Patienten/-innen mit aneurysmatischer Subarachnoidalblutung

Proper management of systolic blood pressure (SBP) after aneurysm rupture is considered important for the prevention of aneurysm rebleeding. However, there is no consensus on the optimal values for SBP in patients with subarachnoid hemorrhage (SAH) prior to aneurysm occlusion. We aimed at analyzing the association between the initial SBP and complications and outcome of SAH patients.

All consecutive SAH patients who were admitted to our department between 2003 and 2016 and treated within the first 48 hours after ictus were included in the analysis. SBP values were collected from external (paramedic) and internal (intensive care unit) protocols. Baseline characteristics of patients and SAH as well as data on early complications and functional outcome (in-hospital mortality and unfavorable outcome at 6 months measured as modified Rankin scale>3) were recorded. SBP values were divided into three categories according to the receiver operating characteristic curve analysis: <140 (category 1), 140-180 (category 2) and >180 mmHg (category 3). Associations were adjusted for relevant confounders.

The mean initial SBP in the final cohort (n=756) was 164 mmHg (±26), with the distribution of the above-mentioned SBP categories as follows: 11.4%, 70.6% and 18%. Higher age, pre-existing arterial hypertension, male sex, and poor admission WFNS grade showed associations with increased initial SBP values. The higher the SBP levels, the more frequent were the cases of aneurysm rebleeding (3.5%, 6.4%, 9.7%) and in-hospital mortality (15.1%, 19.3%, 25.7%). Accordingly, unfavorable outcome after 6 months was more common in the highest SBP category (43.9%, 38.3%, 53.5%). In the final multivariate analysis, SBP increase was independently associated with increased risk of aneurysm rebleeding (aOR=1.77 per-category-increase, p=0.042), in-hospital mortality (aOR=1.52, p=0.01), and unfavorable outcome (aOR=1.44, p=0.034).

Our findings confirm the role of SBP management for the prevention of aneurysm rebleeding and poor SAH outcome. Aiming for SBP values <140 mmHg until aneurysm occlusion might significantly decrease rebleeding rates and improve patients" outcome. Prospective evaluation of the clinical value of strict SBP management is mandatory to further confirm these findings.