Blood Pressure Management in the Early Phase of Aneurysmal Subarachnoid Hemorrhage: Beliefs, Practices, and the Relationship with Clinical Outcomes

Abstract

This thesis investigates the relationship between elevated blood pressure and aneurysm rebleeding in aneurysmal subarachnoid hemorrhage (aSAH) while also exploring clinicians' practices and beliefs surrounding blood pressure management. With the aim of establishing a program of research evaluating blood pressure management during the early phase of aSAH, the objectives of this thesis were threefold: 1) To review the existing literature on blood pressure and aneurysm rebleeding via a systematic review; 2) To describe clinicians' practices and beliefs through a national survey; and 3) To analyze actual blood pressure management practices via a retrospective cohort study. While no clear relationship between elevated blood pressure and rebleeding was found, the evidence is biased and exclusively observational. Clinicians' self-reported blood pressure targets are consistent prior to securing the aneurysm but otherwise vary; this aligns with actual practice. These findings will inform the design of a clinical trial to assess the safety/efficacy of blood pressure lowering in early aSAH.