Abstract Details

Title Preadmission Anti-hypertensive Agents May Affect Cerebral Vasospasm Risk in Aneurysmal Subarachnoid Hemorrhage

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 091

Objective To determine the association between antihypertensives (anti-HTNs) and outcomes in aneurysmal subarachnoid hemorrhage (aSAH) patients.

Background Cerebral vasospasm (cVSP) is a common complication of aSAH. It has been proposed that preadmission beta-blocker therapy may lower the incidence of cVSP after aSAH; however, this association with other anti-HTNs is unknown.

Design/Methods We performed a retrospective cohort study of consecutive patients with aSAH who were admitted to an academic center from 2016 to 2021. The cohort consisted of 311 aSAH patients (mean age 57 years [SD 13.6], 61% female ;70% white). 157 patients (51%) had a history of hypertension. Their anti-HTNs consisted of beta-blockers (BBs; 17.4%), calcium channel blockers (CCBs; 30%), ACE inhibitors/ARBs (17.4%), thiazides (4%), and hydralazine (11%). All anti-HTNs were discontinued on hospital admission per our institutional protocol. We measured association between preadmission use of anti-HTNs and cVSP on transcranial Doppler and worse outcome (3-month modified Rankin scale 4-6) using binary logistic regression after adjusting for demographics, cardiac history, and aSAH-related factors.

Results Preadmission use of BBs (OR 0.47, 95% CI 0.25–0.90) and hydralazine (OR 0.44, 95% CI 0.2–0.98) were associated with lower odds of cVSP. However, preadmission use of CCBs (OR 2.5, 95% CI 1.5–4.2) was associated with higher odds of cVSP and higher incidence of severe cVSP (p=0.003). Higher number of preadmission anti-HTNs was associated with lower odds of cVSP (OR 0.66 per addition of each agent, 95% CI 0.53–0.84, p=0.01), but there was no association between any classes of anti-HTNs and functional outcome.

Conclusions We found lower rates of cVSP in patients with preadmission use of BBs and hydralazine, and higher rate with higher severity of cVSP in those taking CCBs prior to hospitalization. Further prospective studies and clinical trials are needed to find appropriate anti-HTN regimen in aSAH patients.

Authors/Disclosures
Elijah M. Persad-Paisley PRESENTER	Mr. Persad-Paisley has nothing to disclose.
Alizeh Shamshad	Ms. Shamshad has nothing to disclose.
	No disclosure on file
Christoph Stretz, MD, FAAN (Rhode Island Hospital, Department of Neurology)	The institution of Dr. Stretz has received research support from American Heart Association. The institution of Dr. Stretz has received research support from Duke University Medical Center/NIH. The institution of Dr. Stretz has received research support from University of Cincinnati/NINDS.
Nicholas S. Potter, MD, PhD (Rhode Island Hospital)	Dr. Potter has nothing to disclose.
Linda C. Wendell, MD, FAAN (Mount Auburn Hospital)	Dr. Wendell has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various. An immediate family member of Dr. Wendell has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various. Dr. Wendell has stock in Apple. An immediate family member of Dr. Wendell has stock in Apple.
Bradford B. Thompson, MD (St. Elizabeth’s Medical Center)	Dr. Thompson has nothing to disclose.
Karen L. Furie, MD (RIH/Alpert Medical School of Brown Univ)	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. Dr. Furie has received personal compensation in the range of $50,000-$99,999 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.
Jesse Menville	Ms. Menville has nothing to disclose.
Ali Mahta, MD (Brown University)	Dr. Mahta has received research support from Brown University Health.

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