Blood pressure and the risk of rebleeding and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

• Published in: Journal of critical care Vol. 72; p. 154124
• Main Authors: Gathier, Celine S., Zijlstra, IJsbrand A.J., Rinkel, Gabriel J.E., Groenhof, T. Katrien J., Verbaan, Dagmar, Coert, Bert A., Müller, Marcella C.A., van den Bergh, Walter M., Slooter, Arjen J.C., Eijkemans, Marinus J.C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2022; Elsevier Limited
• Subjects: Aneurysmal subarachnoid hemorrhage; Aneurysms; Blood Pressure; Brain Ischemia - complications; Cerebral Infarction; Critical care; Delayed cerebral ischemia; Hemorrhage; Humans; Intensive care; Intensive Care Units; Ischemia; Medical imaging; Patients; Rebleeding; Stroke; Subarachnoid Hemorrhage - complications; Delayed cerebral ischemia; Intensive care; Rebleeding; Blood pressure; Aneurysmal subarachnoid hemorrhage
• ISSN: 0883-9441; 1557-8615; 1557-8615
• DOI: 10.1016/j.jcrc.2022.154124

Blood pressure is presumably related to rebleeding and delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (aSAH) and could serve as a target to improve outcome. We assessed the associations between blood pressure and rebleeding or DCI in aSAH-patients. In this observational study in 1167 aSAH-patients admitted to the intensive care unit (ICU), adjusted hazard ratio's (aHR) were calculated for the time-dependent association of blood pressure and rebleeding or DCI. The aHRs were presented graphically, relative to a reference mean arterial pressure (MAP) of 100 mmHg and systolic blood pressure (sBP) of 150 mmHg. A MAP below 100 mmHg in the 6, 3 and 1 h before each moment in time was associated with a decreased risk of rebleeding (e.g. within 6 h preceding rebleeding: MAP = 80 mmHg: aHR 0.30 (95% confidence interval (CI) 0.11–0.80)). A MAP below 60 mmHg in the 24 h before each moment in time was associated with an increased risk of DCI (e.g. MAP = 50 mmHg: aHR 2.59 (95% CI 1.12–5.96)). Our results suggest that a MAP below 100 mmHg is associated with decreased risk of rebleeding, and a MAP below 60 mmHg with increased risk of DCI. •In our observational study of 1167 SAH patients, MAP < 100 mmHg was associated with decreased risk of rebleeding.•MAP < 60 mmHg was associated with increased risk of delayed cerebral ischemia (DCI).•Whether optimizing MAP values will in fact prevent rebleeding or DCI could be subject of future prospective research.