Abstract WP435: Acute Blood Pressure Reduction and Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage
Background: Radiographic cerebral infarction (RCI) is a prominent cause of disability after aneurysmal subarachnoid hemorrhage (SAH). Current guidelines for acute blood pressure (BP) management of SAH patients are intended to prevent rebleeding, but their potential impact on RCI is unknown.
HYPOTHESIS: RCI after SAH is associated with more acute BP reduction and lower BP.
METHODS: We evaluated 49 patients with SAH. Clinical and radiographic data were prospectively collected. BP data were electronically retrieved from the medical record. BP was compared with multivariate generalized linear models.
RESULTS: RCI was detected in 19 of 49 patients (38.8%). No rebleeding occurred in any of the patients during their hospital stay. Vasospasm occurred in 8 (16.3%) of patients and was associated with higher systolic and diastolic BP (P<0.001 for both) between days 4 and 14. Historical hypertension was associated with RCI (52.6% vs. 23.3%, P=0.036), although initial systolic (168±37 vs. 151±26 mm Hg, P=0.1) and diastolic BP (90±20 vs. 83±19, P=0.2) were not. In a generalized linear model accounting for time from symptom onset, vasospasm, historical hypertension and a vasospasm by time interaction (since BP augmentation depended on the time from symptom onset), lower systolic (-7, 95%CI -8 to -6 mm Hg, (P<0.001) and diastolic BP (-5, 95%CI -6 to -4 mm Hg, P<0.001) were associated with RCI. There were similar data for change in BP from initial BP.
CONCLUSIONS: RCI after SAH is associated with greater BP reductions and historical hypertension may contribute to this risk. More aggressive BP reduction than recommended by current guidelines, while potentially decreasing the risk of aneurysm rebleeding, may be associated with RCI. Routine perfusion scanning to determine the risk of RCI from reduced perfusion may be warranted.
- © 2012 by American Heart Association, Inc.