Acta Neurochirurgica

, Volume 160, Issue 12, pp 2401–2407 | Cite as

Effect of premorbid hypertension control on outcome of patients with aneurysmal subarachnoid hemorrhage

  • Jianfeng Zheng
  • Rui Xu
  • Guojing Liu
  • Zongduo Guo
  • Xiaochuan SunEmail author
Original Article - Vascular Neurosurgery - Aneurysm
Part of the following topical collections:
  1. Vascular Neurosurgery – Aneurysm



Hypertension is common in patients with aneurysmal subarachnoid hemorrhage (SAH). However, it is still unclear whether premorbid antihypertensive therapy can help to reduce the risk of severe aneurysmal bleeding. Therefore, this study aims to assess the effect of premorbid hypertension control on outcome of patients with aneurysmal SAH.


We retrospectively reviewed the clinical data of patients with intracranial aneurysms admitted to our institution from February 2012 to December 2017. Based on premorbid hypertension history and use of antihypertensive agents, all patients with aneurysmal SAH were divided into antihypertensive group and uncontrolled group. Patient characteristics, imaging features, clinical complication, and outcome were analyzed between the two groups.


A total of 348 patients with ruptured aneurysms were included in this study. Compared to those with premorbid controlled hypertension, patients with premorbid uncontrolled hypertension presented worse clinical grade, with more severe aneurysmal SAH and more frequent intracerebral hematoma. Patients receiving a treatment for ACEI type or ARB type of drugs in the antihypertensive group suffered from less amount of aneurysmal bleeding, while patients with grade 3 hypertension in the uncontrolled group suffered from more amount of aneurysmal bleeding. Patients with premorbid controlled hypertension had a lower incidence of rebleeding, hydrocephalus, and cerebral vasospasm, and had a lower rate of disability and mortality.


Premorbid hypertension control is associated with favorable clinical outcome of patients with aneurysmal SAH. Besides, the ACEI type or ARB type of antihypertensive agents is associated with the less amount of bleeding after aneurysm rupture.


Intracranial aneurysm Subarachnoid hemorrhage Antihypertensive treatment Outcome 



National Natural Science Foundation of China (No. 81671160; No. 81571159) and 13th Five-Year National Key Research Project of China (2016YFC1300800; 2016YFC1300804; 2016YFC1300805) provided financial support. The sponsor had no role in the design or conduct of this research.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (Chongqing Medical University First Affiliated Hospital) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.


  1. 1.
    Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, Hoh BL, Kirkness CJ, Naidech AM, Ogilvy CS, Patel AB, Thompson BG, Vespa P (2012) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 43:1711–1737CrossRefGoogle Scholar
  2. 2.
    Larrew T, Pryor W 3rd, Weinberg J, Webb S, Battenhouse H, Turk AS, Chaudry I, Spiotta A, Turner R (2015) Aneurysmal subarachnoid hemorrhage: a statewide assessment of outcome based on risk factors, aneurysm characteristics, and geo-demography. J Neurointerv Surg 7:855–860CrossRefGoogle Scholar
  3. 3.
    Lindner SH, Bor AS, Rinkel GJ (2010) Differences in risk factors according to the site of intracranial aneurysms. J Neurol Neurosurg Psychiatry 81:116–118CrossRefGoogle Scholar
  4. 4.
    Steiner T, Juvela S, Unterberg A, Jung C, Forsting M, Rinkel G (2013) European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis 35:93–112CrossRefGoogle Scholar
  5. 5.
    Shiue I, Arima H, Hankey GJ, Anderson CS (2011) Location and size of ruptured intracranial aneurysm and serious clinical outcomes early after subarachnoid hemorrhage: a population-based study in Australasia. Cerebrovasc Dis 31:573–579CrossRefGoogle Scholar
  6. 6.
    De Marchis GM, Lantigua H, Schmidt JM, Lord AS, Velander AJ, Fernandez A, Falo MC, Agarwal S, Connolly ES Jr, Claassen J, Mayer SA (2014) Impact of premorbid hypertension on haemorrhage severity and aneurysm rebleeding risk after subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 85:56–59CrossRefGoogle Scholar
  7. 7.
    Jaja BN, Lingsma H, Schweizer TA, Thorpe KE, Steyerberg EW, Macdonald RL (2015) Prognostic value of premorbid hypertension and neurological status in aneurysmal subarachnoid hemorrhage: pooled analyses of individual patient data in the SAHIT repository. J Neurosurg 122:644–652CrossRefGoogle Scholar
  8. 8.
    Lindgren A, Turner EB, Sillekens T, Meretoja A, Lee JM, Hemmen TM, Koivisto T, Alberts M, Lemmens R, Jääskeläinen JE, Vergouwen MDI, Rinkel GJE (2018) Outcome after clipping and coiling for aneurysmal subarachnoid hemorrhage in clinical practice in Europe, USA, and Australia. Neurosurgery.
  9. 9.
    Stranjalis G, Loufardaki M, Koutsarnakis C, Kalamatianos T (2016) Trends in the management and hospital outcome of spontaneous subarachnoid hemorrhage in the post-international subarachnoid aneurysm trial era in Greece: analysis of 719 patients during a 13-year period. World Neurosurg 88:327–332CrossRefGoogle Scholar
  10. 10.
    Zhao B, Tan X, Yang H, Li Z, Zheng K, Xiong Y, Zhong M (2016) Endovascular coiling versus surgical clipping for poor-grade ruptured intracranial aneurysms: postoperative complications and clinical outcome in a multicenter poor-grade aneurysm study. AJNR Am J Neuroradiol 37:873–878CrossRefGoogle Scholar
  11. 11.
    Lord AS, Fernandez L, Schmidt JM, Mayer SA, Claassen J, Lee K, Connolly ES, Badjatia N (2012) Effect of rebleeding on the course and incidence of vasospasm after subarachnoid hemorrhage. Neurology 78:31–37CrossRefGoogle Scholar
  12. 12.
    Kim BJ, Kang HG, Kwun BD, Ahn JS, Lee J, Lee SH, Kang DW, Kim JS, Kwon SU (2017) Small versus large ruptured intracranial aneurysm concerns with the site of aneurysm. Cerebrovasc Dis 43:139–144CrossRefGoogle Scholar
  13. 13.
    Tominari S, Morita A, Ishibashi T, Yamazaki T, Takao H, Murayama Y, Sonobe M, Yonekura M, Saito N, Shiokawa Y, Date I, Tominaga T, Nozaki K, Houkin K, Miyamoto S, Kirino T, Hashi K, Nakayama T (2015) Unruptured Cerebral Aneurysm Study Japan Investigators. Prediction model for 3-year rupture risk of unruptured cerebral aneurysms in Japanese patients. Ann Neurol 77:1050–1059CrossRefGoogle Scholar
  14. 14.
    Can A, Castro VM, Ozdemir YH, Dagen S, Yu S, Dligach D, Finan S, Gainer V, Shadick NA, Murphy S, Cai T, Savova G, Dammers R, Weiss ST, Du R (2017) Association of intracranial aneurysm rupture with smoking duration, intensity, and cessation. Neurology 89:1408–1415CrossRefGoogle Scholar
  15. 15.
    Tawk RG, Grewal SS, Heckman MG, Navarro R, Ferguson JL, Starke EL, Rawal B, Hanel R, Miller D, Wharen RE, Freeman WD (2015) Influence of body mass index and age on functional outcomes in patients with subarachnoid hemorrhage. Neurosurgery 76:136–141CrossRefGoogle Scholar
  16. 16.
    Vlak MH, Rinkel GJ, Greebe P, Algra A (2013) Risk of rupture of an intracranial aneurysm based on patient characteristics: a case-control study. Stroke 44:1256–1259CrossRefGoogle Scholar
  17. 17.
    Hamade YJ, Zammar SG, El Tecle NE, El Ahmadieh TY, Chandler JP, Bendok BR (2014) Hypertension and intracranial aneurysms: association or causation? World Neurosurg 82:e665–e667CrossRefGoogle Scholar
  18. 18.
    Lee HJ, Jang SI, Park EC (2017) Effect of adherence to antihypertensive medication on stroke incidence in patients with hypertension: a population-based retrospective cohort study. BMJ Open 7:e014486CrossRefGoogle Scholar
  19. 19.
    Lindgren AE, Kurki MI, Riihinen A, Koivisto T, Ronkainen A, Rinne J, Hernesniemi J, Eriksson JG, Jääskeläinen JE, von und zu Fraunberg M (2014) Hypertension predisposes to the formation of saccular intracranial aneurysms in 467 unruptured and 1053 ruptured patients in Eastern Finland. Ann Med 46:169–176CrossRefGoogle Scholar
  20. 20.
    Shiue I, Hankey GJ, Arima H, Anderson CS (2011) Suboptimal awareness and control of hypertension increases the risk of subarachnoid hemorrhage in the community: results from the ACROSS. Neurol Res 33:1068–1071CrossRefGoogle Scholar
  21. 21.
    Nuki Y, Tsou TL, Kurihara C, Kanematsu M, Kanematsu Y, Hashimoto T (2009) Elastase-induced intracranial aneurysms in hypertensive mice. Hypertension 54:1337–1344CrossRefGoogle Scholar
  22. 22.
    Tada Y, Wada K, Shimada K, Makino H, Liang EI, Murakami S, Kudo M, Kitazato KT, Nagahiro S, Hashimoto T (2014) Roles of hypertension in the rupture of intracranial aneurysms. Stroke 45:579–586CrossRefGoogle Scholar
  23. 23.
    Lagares A, Jiménez-Roldán L, Gomez PA, Munarriz PM, Castaño-León AM, Cepeda S, Alén JF (2015) Prognostic value of the amount of bleeding after aneurysmal subarachnoid hemorrhage: a quantitative volumetric study. Neurosurgery 77:898–907CrossRefGoogle Scholar
  24. 24.
    Salary M, Quigley MR, Wilberger JE Jr (2007) Relation among aneurysm size, amount of subarachnoid blood, and clinical outcome. J Neurosurg 107:13–17CrossRefGoogle Scholar
  25. 25.
    Griessenauer CJ, Tubbs RS, Foreman PM, Chua MH, Vyas NA, Lipsky RH, Lin M, Iyer R, Haridas R, Walters BC, Chaudry S, Malieva A, Wilkins S, Harrigan MR, Fisher WS 3rd, Shoja MM (2018) Association of renin-angiotensin system genetic polymorphisms and aneurysmal subarachnoid hemorrhage. J Neurosurg 128:86–93CrossRefGoogle Scholar
  26. 26.
    Slowik A, Borratynska A, Pera J, Betlej M, Dziedzic T, Krzyszkowski T, Czepko R, Figlewicz DA, Szczudlik A (2004) II genotype of the angiotensin-converting enzyme gene increases the risk for subarachnoid hemorrhage from ruptured aneurysm. Stroke 35:1594–1597CrossRefGoogle Scholar
  27. 27.
    Kaddumukasa M, Ddumba E, Duncan P, Goldstein LB (2012) Poststroke hypertension in Africa. Stroke 43:3402–3404CrossRefGoogle Scholar
  28. 28.
    Kettani FZ, Dragomir A, Côté R, Roy L, Bérard A, Blais L, Lalonde L, Moreau P, Perreault S (2009) Impact of a better adherence to antihypertensive agents on cerebrovascular disease for primary prevention. Stroke 40:213–220CrossRefGoogle Scholar
  29. 29.
    Pittman DG, Tao Z, Chen W, Stettin GD (2010) Antihypertensive medication adherence and subsequent healthcare utilization and costs. Am J Manag Care 16:568–576PubMedGoogle Scholar
  30. 30.
    Shin S, Song H, Oh SK, Choi KE, Kim H, Jang S (2013) Effect of antihypertensive medication adherence on hospitalization for cardiovascular disease and mortality in hypertensive patients. Hypertens Res 36:1000–1005CrossRefGoogle Scholar
  31. 31.
    Rosengart AJ, Schultheiss KE, Tolentino J, Macdonald RL (2007) Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage. Stroke 38:2315–2321CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Jianfeng Zheng
    • 1
  • Rui Xu
    • 1
  • Guojing Liu
    • 1
  • Zongduo Guo
    • 1
  • Xiaochuan Sun
    • 1
    Email author
  1. 1.Department of NeurosurgeryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina

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