The effect of induced hypertension in aneurysmal subarachnoid hemorrhage:  A narrative review

Amirhossein  Azari Jafari; Seyyedmohammadsadeq Mirmoeeni; William Chase Johnson; Muffaqam Shah; Maryam Sadat Hassani; Shahrzad Nazari; Tristan Fielder; Ali Seifi

doi:10.18502/cjn.v22i3.13799

Amirhossein Azari Jafari Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
Seyyedmohammadsadeq Mirmoeeni Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
William Chase Johnson Department of Neurosurgery, Division of Neuro Critical Care, University of Texas Health Science Center at San Antonio School of Medicine, San Antonio, Texas, USA
Muffaqam Shah Deccan College of Medical Sciences, Owaisi Hospital and Research Centre, Hyderabad, Telangana State, India
Maryam Sadat Hassani Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
Shahrzad Nazari Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
Tristan Fielder University of Texas Health Science Center at San Antonio School of Medicine, San Antonio, Texas, USA
Ali Seifi Department of Neurosurgery, Division of Neuro Critical Care, University of Texas Health Science Center at San Antonio School of Medicine, San Antonio, Texas, USA

DOI: https://doi.org/10.18502/cjn.v22i3.13799

Keywords: Aneurysmal Subarachnoid Hemorrhage; Cerebrovascular Disorders; Cardiovascular Disease; Induced Hypertension

Abstract

Aneurysmal subarachnoid hemorrhage ‎(aSAH) ‎accounts for 2-5% of all strokes, and 10%‐15% of ‎aSAH patients will not survive until hospital admission. Induced hypertension (IH) is an emerging therapeutic option being used for the treatment of vasospasm in ‎aSAH. For patients with cerebral vasospasm (CVS) consequent to SAH, IH is implemented to increase systolic blood pressure (SBP) in order to optimize cerebral blood flow (CBF) and prevent delayed cerebral ischemia (DCI). Prophylactic use of IH has been associated with the development of vasospasm and cerebral ischemia in SAH patients. Various trials have defined several different parameters to help clinicians decide when to initiate IH in a SAH patient. However, there is insufficient evidence to recommend therapeutic IH in aSAH due to the possible serious complications like myocardial ischemia, development of posterior reversible encephalopathy syndrome (PRES), pulmonary edema, and even rupture of another unsecured aneurysm. This narrative review showed the favorable impact of IH therapy on aSAH patients; however, it is crucial to conduct further clinical and molecular experiments to shed more light on the effects of IH in aSAH.