Terrett Luke A, Reszel Jessica, Ameri Sara, Turgeon Alexis F, McIntyre Lauralyn, English Shane W
School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
Neurocrit Care. 2025 Apr;42(2):351-362. doi: 10.1007/s12028-024-02138-4. Epub 2024 Oct 14.
In aneurysmal subarachnoid hemorrhage, rebleeding prior to securing the culprit aneurysm leads to significant morbidity and mortality. Elevated blood pressure has been identified as a possible risk factor. In this systematic review, we evaluated the association between elevated blood pressure and aneurysm rebleeding during the unsecured period. We searched MEDLINE, Embase + Embase Classic, and CENTRAL, from inception to March 8th, 2024. We included studies of adults with aneurysmal subarachnoid hemorrhage reporting at least one blood pressure measurement during the unsecured period and a measure of association with rebleeding. Results were stratified by blood pressure thresholds, effect measure, and adjustment for confounding. Separate meta-analyses were performed for each of these groups. Our search identified 5,209 citations. After screening, 15 studies were included in our review. All studies were observational in design and at moderate or high risk of bias. Meta-analysis of the unadjusted results produced mixed findings across the systolic blood pressure (SBP) thresholds: SBP > 140 mm Hg, unadjusted odds ratio (uOR) 1.03 (95% confidence interval [CI] 0.55-1.93; I = 66%); SBP > 160 mm Hg, uOR 3.35 (95% CI 1.44-7.81; I = 83%); SBP > 180 mm Hg, uOR 1.52 (95% CI 0.40-5.81; I = 89%); and SBP > 200 mm Hg, uOR 7.99 (95% CI 3.60-17.72; I = 0%). Meta-analysis of adjusted results was only possible at an SBP > 160 mm Hg; adjusted hazard ratio 1.13 (95% CI 0.98-1.31; I = 0%). The overall quality of evidence as assessed by the Grading of Recommendations, Assessment, Development, and Evaluations tool was rated as very low. Based on very low quality evidence, our systematic review failed to determine whether there is an association between elevated blood pressure during the unsecured period and increased risk of culprit aneurysm rebleeding.
在动脉瘤性蛛网膜下腔出血中，在锁定责任动脉瘤之前再出血会导致显著的发病率和死亡率。血压升高已被确定为一个可能的危险因素。在这项系统评价中，我们评估了血压升高与未锁定期间动脉瘤再出血之间的关联。我们检索了MEDLINE、Embase + Embase Classic和CENTRAL，检索时间从数据库建立至2024年3月8日。我们纳入了关于动脉瘤性蛛网膜下腔出血成人患者的研究，这些研究报告了未锁定期间至少一次血压测量以及与再出血的关联测量。结果按血压阈值、效应量和混杂因素调整进行分层。对这些组分别进行了荟萃分析。我们的检索共识别出5209条引文。经过筛选，15项研究被纳入我们的评价。所有研究均为观察性设计，且存在中度或高度偏倚风险。对未调整结果的荟萃分析在不同收缩压（SBP）阈值下得出了混合结果：SBP > 140 mmHg，未调整优势比（uOR）为1.03（95%置信区间[CI] 0.55 - 1.93；I = 66%）；SBP > 160 mmHg，uOR为3.35（95% CI 1.44 - 7.81；I = 83%）；SBP > 180 mmHg，uOR为1.52（95% CI 0.40 - 5.81；I = 89%）；SBP > 200 mmHg，uOR为7.99（95% CI 3.60 - 17.72；I = 0%）。仅在SBP > 160 mmHg时才能对调整后的结果进行荟萃分析；调整后风险比为1.13（95% CI 0.98 - 1.31；I = 0%）。根据推荐分级、评估、制定和评价工具评估的证据总体质量被评为极低。基于极低质量的证据，我们的系统评价未能确定未锁定期间血压升高与责任动脉瘤再出血风险增加之间是否存在关联。
