Article Text

Impact of premorbid hypertension and renin-angiotensin-aldosterone system inhibitors on the severity of aneurysmal subarachnoid haemorrhage: a multicentre study
  1. Ping Zhong1,2,3,
  2. Zhiwen Lu4,
  3. Zhangyu Li3,
  4. Tianxiao Li5,
  5. Qing Lan6,
  6. Jianmin Liu4,
  7. Sifang Chen3,
  8. Zhanxiang Wang1,2,3,
  9. Qinghai Huang4
  1. 1Department of Neurosurgery and Department of Neuroscience, Fujian Key Laboratory of Brain Tumors Diagnosis and Precision Treatment, Xiamen Key Laboratory of Brain Center, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
  2. 2Department of Neuroscience, Institute of Neurosurgery, School of Medicine, Xiamen University, Xiamen, Fujian, China
  3. 3Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
  4. 4Neurovascular Center, Changhai Hospital, Second Military Medical University, Shanghai, China
  5. 5Neurovascular Center, Henan Provincial People's Hospital, Zhengzhou, Henan Province, China
  6. 6Department of Neurosurgery, Second Affiliated Hospital of Soochow University, Suzhou, China
  1. Correspondence to Dr Qinghai Huang, Neurovascular Center, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China; ocinhqh{at}163.com; Dr Zhanxiang Wang, Department of Neurosurgery and Department of Neuroscience, Fujian Key Laboratory of Brain Tumors Diagnosis and Precision Treatment, Xiamen Key Laboratory of Brain Center, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People's Republic of China; wangzx{at}xmu.edu.cn; Dr. Sifang Chen, Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People's Republic of China; csfsong143{at}aliyun.com

Abstract

Background Hypertension is widely acknowledged as a significant contributory factor to the heightened risk of intracranial aneurysm rupture. Nevertheless, the impact of hypertension management on the outcomes subsequent to aneurysmal subarachnoid haemorrhage (aSAH), particularly concerning the severity of aSAH, remains an underexplored area.

Methods We conducted a retrospective analysis using data from a prospectively multicentre cohort of 4545 patients with aSAH in China. Premorbid hypertension status and the utilisation of antihypertensive medications prior to admission were set as key exposure factors. The primary outcomes encompassed unfavourable clinical grading scales observed on admission. Employing multivariable logistic regression, we explored the association between premorbid hypertension status, preadmission use of renin-angiotensin-aldosterone system (RAAS) inhibitors and unfavourable clinical grading scales.

Results In comparison to patients with normal blood pressure, only uncontrolled hypertension demonstrated a significant and independent association with an elevated risk of poor outcomes on the Hunt-Hess scale (OR=1.799, 95% CI 1.413 to 2.291, p<0.001) and the World Federation of Neurological Surgeons (WFNS) scale (OR=1.721, 95% CI 1.425 to 2.079, p<0.001). Furthermore, the antecedent use of RAAS inhibitors before admission was markedly and independently linked to a diminished risk of adverse outcomes on the Hunt-Hess scale (OR=0.653, 95% CI 0.430 to 0.992, p=0.046) and the WFNS scale (OR=0.656, 95% CI 0.469 to 0.918, p=0.014).

Conclusions Uncontrolled hypertension markedly elevates the risk of adverse clinical outcomes following an aSAH. Conversely, the preadmission utilisation of RAAS inhibitors demonstrates a noteworthy association with a favourable clinical outcome after aSAH.

  • Intracranial Aneurysm
  • Hemorrhage
  • Blood Pressure

Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available on request from the corresponding author upon reasonable request.

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This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available on request from the corresponding author upon reasonable request.

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Footnotes

  • Contributors ZLi and ZLu collected the data and performed the research. Data were analysed by PZ. PZ drafted the manuscript. SC, ZW and QH conceived and designed the research. LJ, LT, QL and QH initiated and organised this study. QH accepts full responsibility for the work and the conduct of the study as the guarantor, had access to the data, and controlled the decision to publish. All authors reviewed and edited the manuscript and approved the final version of the manuscript.

  • Funding This study was funded by the National Research and Development Project of Key Chronic Diseases (Grant No. 2016YFC1300703), the Fujian Provincial Natural Science Foundation of China (Grant No. 2021J011367 and No. 2021J011353), the Medical Project of Xiamen Municipal Bureau of Science and Technology (Grant No. 3502Z20214ZD1013), Xiamen Municipal Health Commission, Xiamen Municipal Bureau of Science and Technology (Grant No. 3502Z20209005), Fujian Provincial Clinical Research Center for Brain Diseases (Grant No. 2021FJSLCYX01) and Xiamen Clinical Research Center for Neurological Diseases (Grant No. 2021XMSLCYX01).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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