The Effect of Induced Hypertension in Aneurysmal Subarachnoid Hemorrhage: A Narrative Review Publisher



Jafari AA¹ ; Mirmoeeni S¹ ; Johnson WC² ; Shah M³ ; Hassani MS¹ ; Nazari S⁴ ; Fielder T⁵ ; Seifi A²
Source: Current Journal of Neurology Published:2023

Abstract

Aneurysmal subarachnoid hemorrhage (aSAH) accounts for 2-5% of all strokes, and 10%‐15% of aSAH patients will not survive until hospital admission. Induced hypertension (IH) is an emerging therapeutic option being used for the treatment of vasospasm in aSAH. For patients with cerebral vasospasm (CVS) consequent to SAH, IH is implemented to increase systolic blood pressure (SBP) in order to optimize cerebral blood flow (CBF) and prevent delayed cerebral ischemia (DCI). Prophylactic use of IH has been associated with the development of vasospasm and cerebral ischemia in SAH patients. Various trials have defined several different parameters to help clinicians decide when to initiate IH in a SAH patient. However, there is insufficient evidence to recommend therapeutic IH in aSAH due to the possible serious complications like myocardial ischemia, development of posterior reversible encephalopathy syndrome (PRES), pulmonary edema, and even rupture of another unsecured aneurysm. This narrative review showed the favorable impact of IH therapy on aSAH patients; however, it is crucial to conduct further clinical and molecular experiments to shed more light on the effects of IH in aSAH. © 2023 Iranian Neurological Association, and Tehran University of Medical Sciences.