Association of Blood Pressure Parameters in Unsecured Aneurysmal Subarachnoid Hemorrhage and Outcomes (P14-5.017)

Abstract

<h3>Objective:</h3> To investigate the association between BP parameters, MAP, rebleeding events, and outcomes for aSAH patients. <h3>Background:</h3> Elevated systolic blood pressure (SBP) has been linked to pre-procedural rebleeding risk and poor outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). However, the relationship between blood pressure parameters including mean arterial pressure (MAP) with rebleeding prior to and after aneurysm securement remains unclear. This study seeks to determine the association between BP parameters and rebleeding events and outcomes in patients with aSAH. <h3>Design/Methods:</h3> We performed a retrospective analysis of consecutive patients with aSAH admitted to an academic center between 2016–2022. BP values were recorded hourly from admission. Per our institutional protocol, the SBP target is &lt;140 mmHg for all unsecured aSAH aneurysms. Rebleeding was defined as radiographic worsening of hemorrhage prior to or immediately following aneurysm securement. Binary regression analysis was used to determine the association of maximum recorded BP with rebleeding and poor functional outcome (modified Rankin Scale [mRS] 4–6 at 3 months post-discharge). <h3>Results:</h3> The cohort included 325 patients (mean age 57 years [SD 13.4], 61% female, 87% received endovascular treatments, 13% surgical clipping). Two or more consecutive SBP values &gt;140 were seen in 41% and &gt;160 in 15% of patients. Rebleeding prior to or during securing aneurysms including intra-procedural bleeding occurred in 48 patients (15%). There was no association between either maximum recorded SBP (175 mmHg [36.3] vs. 167 [33.4], p=0.12) or MAP (124 mmHg [25.5] vs. 117.9 [22.5], p=0.08) and rebleeding. However, only maximum recorded MAP pre-angiogram was associated with poor outcome (OR 1.014 for 1 mmHg increase in MAP, 95% CI: 1.004–1.03, p=0.006). <h3>Conclusions:</h3> Elevated MAP peri-securement of a ruptured cerebral aneurysm can be associated with poor outcome. Multicenter prospective studies should further examine the association between MAP cut offs and outcomes to consider modifying current guidelines. <b>Disclosure:</b> Miss Haripottawekul has nothing to disclose. Ms. Paracha has nothing to disclose. Ms. Haque has nothing to disclose. Mr. Persad-Paisley has received research support from NIH National Heart, Lung, Blood Institute (NHLBI) . Ms. Shamshad has nothing to disclose. Mr. Meyer has received research support from Brown University - Undergraduate Teaching and Research Award. Dr. Reznik has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Morrison Mahoney. The institution of Dr. Reznik has received research support from NIDUS. The institution of Dr. Furie has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen/BMS. The institution of Dr. Furie has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for ACTICOR. Dr. Furie has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for BMJ/JNNP. The institution of Dr. Furie has received research support from NINDS. Dr. Yaghi has nothing to disclose. Dr. Mahta has nothing to disclose.