Artikel
Spontaneous rise in blood pressure early after SAH – An epiphenomenon of disease severity and demand or a surrogate for outcome?
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Autoren
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Fritz Teping
- Klinik für Neurochirurgie, Uniklinikum RWTH Aachen, Germany
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Walid Albanna
- Klinik für Neurochirurgie, Uniklinikum RWTH Aachen, Germany
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Hans Clusmann
- Klinik für Neurochirurgie, Uniklinikum RWTH Aachen, Germany
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Anke Höllig
- Klinik für Neurochirurgie, Uniklinikum RWTH Aachen, Germany
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Henna Schulze-Steinen
- Klinik für Operative Intensivmedizin und Intermediate Care, Uniklinikum RWTH Aachen, Germany
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Gerrit Alexander Schubert
- Klinik für Neurochirurgie, Uniklinikum RWTH Aachen, Germany
| Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: Spontaneous increase in blood pressure is frequently noted during the observation period after aneurysmal subarachnoid hemorrhage (aSAH). These episodes of spontaneous hypertension (ESH) are usually permitted, as they are thought to represent an endogenous response to maintain cerebral perfusion. The relevance of this observation, however, remains obscure. A detailed analysis of blood pressure variability and its relationship to disease severity and outcome is the purpose of this study.
Method: A total of 80 consecutive patients (mean age 53.7 ± 13.6yrs) with aSAH were included for this retrospective analysis of a prospectively collected data pool. In addition to demographic data, clinical severity (HH grade, modified Fisher grade), modality of treatment (clip vs coil), development of DCI, need for endovascular rescue therapy, cerebral infarction and outcome (GOS) after three months were recorded. Hemodynamic information was analyzed for ESH after exclusion of iatrogenic factors (drug- or volume-induced therapy, external manipulation) and defined as follows: increase of systolic blood pressure (SBP) ≥ 15mmHg, 25mmHg or 35mmHg or increase of mean arterial blood pressure (MAP) ≥ 10mmHg, 15mmHg or 25mmHg over at least 8 out of 12 consecutive readings (=3hrs). Subgroup analysis included stratification for day 4-14 versus day 0-3/14-21.
Results: A total of 264.000 electronical data sets were analyzed. ESH incidence varied from 17-84% depending on the detection threshold for significant blood pressure increase (15-35mmHg) and the time period under scrutiny. Incidence of ESH was not influenced by the modality of treatment, but ESH was significantly more likely to occur between day 4-14 for all thresholds (p<0.001) and also in posterior circulation aneurysms (p<0.05). ESH was associated with disease severity upon admission (p<0.05), but not with a need for rescue therapy, DCI, cerebral infarction or outcome after three months.
Conclusions: Spontaneous hypertension is a frequent phenomenon after aSAH. Our data supports the hypothesis of ESH as an endogenous, demand-driven upregulation, which correlates with disease severity, but – if permitted – does not translate into a higher risk for bad outcome. These findings will have to be confirmed in an even larger cohort of patients.
