Evidence map›Paper›PMID 29619659›Full record

ArticleNeurocritical care2018

Spontaneous Elevation of Blood Pressure After SAH: An Epiphenomenon of Disease Severity and Demand, But Not a Surrogate for Outcome?

F Teping, W Albanna, H Clusmann, H Schulze-Steinen, M Mueller, A Hoellig, G A Schubert

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Article in Neurocritical care, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

F TepingDepartment of Neurosurgery, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
W AlbannaDepartment of Neurosurgery, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
H ClusmannDepartment of Neurosurgery, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
H Schulze-SteinenDepartment of Operative Intensive Care and Intermediate Care, RWTH Aachen University, Aachen, Germany.
M MuellerDepartment of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Aachen, Germany.
A HoelligDepartment of Neurosurgery, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
G A SchubertDepartment of Neurosurgery, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany. gschubert@ukaachen.de.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSpontaneous blood pressure increase is frequently observed after aneurysmal subarachnoid hemorrhage (aSAH). These episodes of spontaneous blood pressure alterations are usually tolerated under the assumption of an endogenous response to maintain cerebral perfusion. The relevance of blood pressure variability and its relationship to disease severity and outcome, however, remain obscure.

methodsA total of 115 consecutive patients with aSAH were included for this retrospective analysis of a continuously collected data pool. Demographics, initial clinical severity of aSAH (HH°, mFS), treatment modality, clinical course, and outcome (development of DCI, cerebral infarction, and GOS after 3 months) were recorded. Hemodynamic information-recorded automatically with a frequency of 1/15 min-was analyzed for spontaneous blood pressure increase (SBI) and endogenous persistent hypertension (EPH) after exclusion of iatrogenic factors and relevant co-medication. Subgroup analysis included stratification for day 0-3, 4-14, and 14-21.

resultsSBI and EPH incidence varied from 17 to 84% depending on detection threshold (15-35 mmHg) and time period under scrutiny. Incidence of blood pressure increase correlated with disease severity upon admission (p < 0.05), but the anticipated association with outcome was not observed. SBI and EPH were more likely to occur between day 4 and 14 (p < 0.001), but only early occurrence (day 0-3) was associated with higher incidence of DCI (p < 0.05). Persistent blood pressure elevation between day 4 and 21 was associated with fewer DCI. However, no influence of spontaneous upregulation on clinical outcome after three months was observed.

conclusionsSpontaneous hemodynamic upregulation is a frequent phenomenon after aSAH. Our data support the hypothesis that spontaneous blood pressure alterations reflect an endogenous, demand-driven response correlating with disease severity. Early alterations may indicate an aggravated clinical course, while later upregulation in particular-if permitted-does not translate into a higher risk of unfavorable outcome.

Indexed as

Outcome Assessment, Health CareSeverity of Illness IndexAdultAgedBlood PressureFemaleHomeostasisHumansHypertensionMaleMiddle AgedSubarachnoid HemorrhageVasospasm, IntracranialAutoregulationCerebral vasospasmPermissive hypertensionSpontaneous hypertensionSpontaneous upregulationSubarachnoid hemorrhage (SAH)

Identifiers

PMID29619659

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.