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Is hypertension a major risk factor in aneurysmal subarachnoid hemorrhage?
Güther Kleinpeter1, Stephan Lehr
1Neurochirurgische Abteilung, Donauspital, Wien, Austria. g.kleinpeter@billrothhaus.at
Insights
Hypertension significantly increases the risk of subarachnoid hemorrhage from cerebral aneurysms. This study suggests aneurysms are acquired, hemodynamically induced chronic diseases, with hypertension being a key factor.
Area of Science:
- Neurology
- Vascular Medicine
- Epidemiology
Background:
- The role of hypertension in cerebral aneurysm development and rupture is debated.
- Understanding risk factors is crucial for preventing subarachnoid hemorrhage (SAH).
Purpose of the Study:
- To investigate the association between hypertension and cerebral aneurysms.
- To evaluate other risk factors like smoking, body weight, hematocrit, fibrinogen, and leukocrit.
Main Methods:
- A hospital-based case-control and cohort study.
- Investigated 141 patients with SAH and verified cerebral aneurysms.
- Utilized stepwise logistic regression to analyze risk factors.
Main Results:
- Hypertension showed a strong association with SAH (Odds Ratio [OR] = 6.8).
- Smoking also increased risk (OR = 2.2).
- Age was a significant prognostic factor and a confounder for hypertension.
Conclusions:
- Hypertensive patients had a nearly seven-fold higher risk of aneurysmal SAH.
- Findings support the hypothesis that cerebral aneurysms are acquired, hemodynamically induced chronic diseases.
Objective:
The role of hypertension as a major risk factor for the development and rupture of cerebral aneurysms is a subject of considerable debate.
Methods:
In order to substantiate or weaken the hypothesis of the atherogenic, degenerative origin of this disease, in addition to hypertension the influence of smoking and the covariates body weight, hematocrit, fibrinogen and leukocrit were examined in a hospital-based case-control and cohort study. 141 consecutive patients with subarachnoid hemorrhage (SAH) and verified cerebral aneurysms, admitted between September 1994 and August 1998, were investigated.
Results:
An association was found between hypertension and SAH of cerebral aneurysm in the entire patient group (P < 0.0001). In the stepwise logistic regression, the exposure odds ratio (OR) for hypertension was 6.8 (CI (95%): 3.53-13.14). Smokers have a twofold higher risk, with an OR of 2.2 (CI (95%): 1.19-4.06). Age was found to have a prognostic impact on the disease (P = 0.0089). Age obviously was a confounding factor for hypertension, which was associated with the outcome (P = 0.048).
Conclusion:
Patients with hypertension had a nearly seven-fold higher risk of aneurysmal subarchnoid hemorrhage. This seems to substantiate the hypothesis that aneurysm is an acquired and hemodynamically induced chronic disease.