Postoperative Blood Pressure and Outcomes in Aneurysmal Subarachnoid Hemorrhage

BackgroundOptimal postoperative blood pressure (BP) management remains unclear for hypertensive patients with aneurysmal subarachnoid hemorrhage (aSAH). We investigated associations of early postoperative BP levels, variability, and trajectories with 6 month outcomes. MethodsConsecutive hypertensive patients after aSAH surgery were retrospectively analyzed. BP was measured four times daily for 3 days. Profiles included minimum systolic BP (SBP), mean arterial pressure, variability, and SBP trajectories. Minimum SBP was dichotomized at 140 mmHg to examine threshold effects. Multivariable logistic regression assessed associations between BP metrics and functional outcome. Causal mediation analysis evaluated the indirect effect of delayed cerebral ischemia (DCI) on the association between minimum SBP (140 mmHg cutoff) and outcome. ResultsAmong 702 patients, lower SBP in the first 3 days independently predicted poor outcomes (OR = 0.98). Maintaining SBP [≥]140 mmHg was linked to lower risks of unfavorable outcomes (OR = 0.44) and DCI (OR = 0.49). Mediation analysis indicated 35% of this effect was explained by reduced DCI. Higher BP variability, measured by standard deviation and coefficient of variation, correlated with poor outcomes. Trajectory analysis showed that moderately rising SBP ([≥]140 mmHg) was associated with the favorable outcomes. ConclusionsMaintaining SBP [≥]140 mmHg with stable variability in the early postoperative period was associated with favorable functional outcomes, partly through reducing DCI. These findings highlight the importance of adequately elevated and stable BP management after aSAH surgery.