TY - JOUR
T1 - Clinical response following hypertension induction for clinical delayed cerebral ischemia following subarachnoid hemorrhage
T2 - A retrospective, multicenter, cohort study
AU - Tjerkstra, Maud A.
AU - Müller, Marcella C. A.
AU - Coert, Bert A.
AU - Hoefnagels, Friso W. A.
AU - Vergouwen, Mervyn D. I.
AU - van Vliet, Peter
AU - Ooms, Lizzy
AU - Rinkel, Gabriël J. E.
AU - Slooter, Arjen J. C.
AU - Moojen, Wouter A.
AU - Jellema, Korné
AU - Vandertop, W. Peter
AU - Verbaan, Dagmar
N1 - Funding Information: No funding was obtained for this study. M.D.I.V. was supported by a Clinical Established Investigator grant from the Dutch Heart Foundation (2018T098). Publisher Copyright: © 2023 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
PY - 2023/8
Y1 - 2023/8
N2 - Background: Hypertension induction (HTI) is often used for treating delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH); however, high-quality studies on its efficacy are lacking. We studied immediate and 3−/6-month clinical efficacy of HTI in aSAH patients with clinical DCI. Methods: A retrospective, multicenter, comparative, observational cohort study in aSAH patients with clinical deterioration due to DCI, admitted to three tertiary referral hospitals in the Netherlands from 2015 to 2019. Two hospitals used a strategy of HTI (HTI group) and one hospital had no such strategy (control group). We calculated adjusted relative risks (aRR) using Poisson regression analyses for the two primary (clinical improvement of DCI symptoms at days 1 and 5 after DCI onset) and secondary outcomes (DCI-related cerebral infarction, in-hospital mortality, and poor clinical outcome [modified Rankin Scale 4–6] assessed at 3 or 6 months), using the intention-to-treat principle. We also performed as-treated and per-protocol analyses. Results: The aRR for clinical improvement on day 1 after DCI in the HTI group was 1.63 (95% CI 1.17–2.27) and at day 5 after DCI 1.04 (95% CI 0.84–1.29). Secondary outcomes were comparable between the groups. The as-treated and per-protocol analyses yielded similar results. Conclusions: No clinical benefit of HTI is observed 5 days after DCI due to spontaneous reversal of DCI symptoms in patients treated without HTI. The 3−/6-month clinical outcome was similar for both groups. Therefore, these data suggest that one may consider to not apply HTI in aSAH patients with clinical DCI.
AB - Background: Hypertension induction (HTI) is often used for treating delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH); however, high-quality studies on its efficacy are lacking. We studied immediate and 3−/6-month clinical efficacy of HTI in aSAH patients with clinical DCI. Methods: A retrospective, multicenter, comparative, observational cohort study in aSAH patients with clinical deterioration due to DCI, admitted to three tertiary referral hospitals in the Netherlands from 2015 to 2019. Two hospitals used a strategy of HTI (HTI group) and one hospital had no such strategy (control group). We calculated adjusted relative risks (aRR) using Poisson regression analyses for the two primary (clinical improvement of DCI symptoms at days 1 and 5 after DCI onset) and secondary outcomes (DCI-related cerebral infarction, in-hospital mortality, and poor clinical outcome [modified Rankin Scale 4–6] assessed at 3 or 6 months), using the intention-to-treat principle. We also performed as-treated and per-protocol analyses. Results: The aRR for clinical improvement on day 1 after DCI in the HTI group was 1.63 (95% CI 1.17–2.27) and at day 5 after DCI 1.04 (95% CI 0.84–1.29). Secondary outcomes were comparable between the groups. The as-treated and per-protocol analyses yielded similar results. Conclusions: No clinical benefit of HTI is observed 5 days after DCI due to spontaneous reversal of DCI symptoms in patients treated without HTI. The 3−/6-month clinical outcome was similar for both groups. Therefore, these data suggest that one may consider to not apply HTI in aSAH patients with clinical DCI.
KW - aneurysmal subarachnoid hemorrhage
KW - delayed cerebral ischemia
KW - hypertension induction
KW - intracranial vasospasm
UR - http://www.scopus.com/inward/record.url?scp=85160961976&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/ene.15833
DO - https://doi.org/10.1111/ene.15833
M3 - Article
C2 - 37151098
SN - 1351-5101
VL - 30
SP - 2278
EP - 2287
JO - European journal of neurology
JF - European journal of neurology
IS - 8
ER -