Impact of premorbid hypertension and renin-angiotensin-aldosterone system inhibitors on the severity of aneurysmal subarachnoid haemorrhage: a multicentre studyPing Zhong, Zhiwen Lu, Zhangyu Li, Tianxiao Li, Qing Lan, Jianmin Liu, Sifang Chen, Zhanxiang Wang, Qinghai Huangdoi: 10.1136/svn-2023-003052
Stroke & Vascular Neurology（SVN）最新上线文章“Impact of premorbid hypertension and renin-angiotensin-aldosterone system inhibitors on the severity of aneurysmal subarachnoid haemorrhage: a multicentre study”，来自上海长海医院黄清海教授、厦门大学附属第一医院王占祥教授、陈四方教授等。高血压被广泛认为是增加颅内动脉瘤破裂风险的重要因素。然而，高血压管理对动脉瘤性蛛网膜下腔出血（aneurysmal subarachnoid haemorrhage, aSAH）后的结局的影响，特别是对aSAH严重程度的影响，仍然是一个尚未充分探索的领域。作者团队使用来自中国的4545例aSAH患者的前瞻性多中心队列数据进行了回顾性分析。病前高血压状态和入院前使用抗高血压药物被设定为关键暴露因素。主要结局包括入院时观察到的不良临床分级量表。采用多变量logistic回归，探讨了病前高血压状态、入院前使用肾素-血管紧张素-醛固酮系统（renin-angiotensin-aldosterone system, RAAS）抑制剂与不良临床分级量表之间的相关性。研究结果：与血压正常的患者相比，仅未控制的高血压与Hunt-Hess量表（OR=1.799, 95%CI 1.413 to 2.291, p<0.001）和世界神经外科医师联盟（World Federation of Neurological Surgeons, WFNS）量表（OR=1.721, 95%CI 1.425 to 2.079, p<0.001）不良结局风险增加具有显著且独立的相关性。此外，入院前使用RAAS抑制剂与Hunt-Hess量表（OR=0.653, 95%CI 0.430 to 0.992, p=0.046）和WFNS量表（OR=0.656, 95%CI 0.469 to 0.918, p=0.014）不良结局风险降低具有显著且独立的相关性。![]()
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Figure 2. Interaction and subgroup analyses for the treatment effect of renin-angiotensin-aldosterone (RAAS) inhibitors on the severity of aneurysmal subarachnoid haemorrhage (aSAH). The beneficial impacts of RAAS inhibitors on Hunt-Hess scale (A) and World Federation of Neurological Surgeons (WFNS) scale (B) were notably pronounced within the subgroup characterised by controlled hypertension, combination therapy and irregular aneurysms. Particularly, the results of the interaction test revealed that hypertension control and age exhibited a significant interaction effect with the use of RAAS inhibitors on outcomes. ‘posterior’ denotes posterior circulation (including the vertebral artery, basilar artery, cerebellar arteries and posterior cerebral artery). ACA, anterior cerebral arteries (including the anterior cerebral artery, anterior communicating artery and pericallosal artery); BMI, body mass index; ICA, internal carotid artery; MCA, middle cerebral artery; PCoA, posterior communicating artery; PLT, platelet.
研究结论：未控制的高血压显著增加了aSAH后不良临床结局的风险。相反，入院前使用RAAS抑制剂与aSAH后良好的临床结局具有显著相关性。更多内容详见文章原文：https://svn.bmj.com/content/early/2024/06/17/svn-2023-003052，或点击文末“阅读原文”。投稿 / 转载 / 商务合作：csa.svn@chinastroke.netEmail：csa.svn@chinastroke.net地址：北京市丰台区南四环西路119号B区1号楼508室本公众号对其刊载的所有内容，包括文字、图片、音视频资料以及版式设计等享有版权，未经本公众号授权同意，其他任何机构不得以任何形式侵犯本公众号作品著作权，包括但不限于：擅自复制、链接、非法使用或转载，或以任何方式建立作品镜像。转载请联系后台或邮箱。如获转载授权，发布请注明出处，不得擅自修改文章内容
