Key result
An intensive systolic blood pressure lowering strategy before aneurysm treatment did not significantly decrease the risk of rebleeding compared to a conservative strategy (HR 0.66).
Why the study?
It remained unclear whether a systolic blood pressure lowering strategy before aneurysm treatment decreases rebleeding risk without increasing the risk of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.
Does an intensive SBP lowering strategy reduce the risk of rebleeding in patients with aneurysmal subarachnoid hemorrhage?
Cohort (n=522)
Yes
Does an intensive SBP lowering strategy reduce the risk of rebleeding in patients with aneurysmal subarachnoid hemorrhage?
Hazard Ratio: 0.66 (95% CI 0.23–1.92)
Absolute Event Rate: 3% vs 8%
An intensive SBP lowering strategy before aneurysm treatment in aSAH patients does not appear to significantly decrease rebleeding risk or increase DCI risk compared to conservative management.
Intensive pre-securing SBP lowering was not associated with reduced rebleeding in aSAH; leaves open benefit in randomized trials.
Background: High systolic blood pressure (SBP) after aneurysmal subarachnoid hemorrhage (aSAH) has been associated with an increased risk of rebleeding. It remains unclear if an SBP lowering strategy before aneurysm treatment decreases this risk without increasing the risk of a delayed cerebral ischemia (DCI). Therefore, we compared the rates of in-hospital rebleeding and DCI among patients with aSAH admitted in two tertiary care centers with different SBP management strategies. Methods: Retrospective cohort study. Consecutive patients from Utrecht and Toulouse admitted within 24 h after the aSAH onset were enrolled. In Toulouse, the target SBP before aneurysm treatment was ≤140 mm Hg, while, in Utrecht, an increased SBP was only treated in extreme situations. We compared SBP levels, the incidence of rebleeding within 24 h after admission, and DCI during hospitalization. Results: . 29 (8%) in Utrecht experienced a rebleeding. After adjustment for Prognosis on Admission of Aneurysmal Subarachnoid Hemorrhage (PAASH) score, aneurysm size, age, and delay from ictus to admission, the HR was 0.66 (95% CI: 0.23-1.92). Incidence of DCI was 18% in Toulouse and 25% in Utrecht (adjusted OR, 0.68; 95% CI: 0.41-1.11). Conclusion: Our results suggest that an intensive SBP lowering strategy between admission and aneurysm treatment does not decrease the risk of rebleeding and does not increase the risk of DCI compared to a more conservative strategy.
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Calvière et al. (2022) conducted a cohort in Aneurysmal subarachnoid hemorrhage (aSAH) (n=522). Intensive systolic blood pressure lowering strategy (target SBP ≤ 140 mm Hg) vs. Conservative systolic blood pressure management strategy was evaluated on In-hospital rebleeding within 24 hours after admission (HR 0.66, 95% CI 0.23-1.92). An intensive systolic blood pressure lowering strategy before aneurysm treatment did not significantly decrease the risk of rebleeding compared to a conservative strategy (HR 0.66).
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