Induced hypertension does not reliably improve outcomes in patients with aneurysmal subarachnoid hemorrhage and delayed cerebral ischemia (DCI), according to findings from a randomized clinical trial published in Stroke.
In this study, participants with aneurysmal subarachnoid hemorrhage and symptoms of DCI were randomly assigned to undergo induced hypertension (n=21) or not undergo induced hypertension (n=20). Prior to calculating risk ratios for the primary end point of poor outcome at 3 months, the investigators adjusted for age, the condition of the patient at admission and time of DCI, and the blood amount seen on initial computed tomography scan.
A greater number of participants in the induced hypertension group experienced poor outcome at 3 months (n=12 [57%]) compared with participants in the group not undergoing induced hypertension (n=8 [40%]). In participants in the induced hypertension group, the adjusted risk ratio for poor outcome at 3 months was 1.0 (95% CI, 0.6-1.8), whereas the risk ratio for serious adverse events at the same time point was 2.1 (95% CI, 0.9-5.0). The investigators halted the trial prematurely due to slow recruitment and a lack of treatment efficacy on overall cerebral perfusions.
As a result of the small population size, this study had insufficient power to arrive at conclusions regarding induced hypertension in patients with subarachnoid hemorrhage and DCI. In addition, a large percentage of patients were excluded prior to the commencement of the trial, further limiting the study.
While the researchers note their data were limited, they suggest that “patients with preexisting cardiopulmonary disease are likely to be at increased risk of developing more serious complications” following induced hypertension.
Gathier CS, van den Bergh WM, van der Jagt M, et al. Induced hypertension for delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: a randomized clinical trial [published online November 20, 2017]. Stroke. doi:10.1161/STROKEAHA.117.017956