Association Between Regular Blood Pressure Monitoring and the Risk of Intracranial Aneurysm Rupture: a Multicenter Retrospective Study with Propensity Score Matching

Zhong, Ping; Lu, Zhijie; Li, Tianxiao; Lan, Qing; Liu, Jianmin; Wang, Zhanxiang; Chen, Sifang; Huang, Qinghai

doi:10.1007/s12975-022-01006-7

Cited by 10 publications

(7 citation statements)

References 39 publications

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“… 21 Therefore, FIA patients with hypertension need more close blood pressure monitoring. 36 In addition, on the basis of the 3D vessel model, L max tended to be longer in dolichoectatic- and transitional-type FIAs than in fusiform-type FIAs ( Table 4 ), which revealed that more complex types of FIAs tend to involve more areas of the culprit artery. Still, longitudinal follow-up studies based on HR-MRI with larger sample sizes are needed to investigate the differences in progression between the three types of FIA.…”

Section: Discussionmentioning

confidence: 92%

Quantification of aneurysm wall enhancement in intracranial fusiform aneurysms and related predictors based on high-resolution magnetic resonance imaging: a validation study

Peng

Xia

et al. 2022

Ther Adv Neurol Disord

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Background: Aneurysm wall enhancement (AWE) in high-resolution magnetic resonance imaging (HR-MRI) has emerged as a new imaging biomarker of intracranial aneurysm instability. Objective: To determine a standard method of AWE quantification for predicting fusiform intracranial aneurysms (FIAs) stability by comparing the sensitivity of each parameter in identifying symptomatic FIAs. The predictors of AWE and FIA types were also identified. Methods: We retrospectively analyzed consecutive fusiform aneurysm patients who underwent HR-MRI from two centers. The aneurysm-to-pituitary stalk contrast ratio (CRstalk), aneurysm enhancement ratio, and aneurysm enhancement index were extracted, and their sensitivities in discriminating aneurysm symptoms were compared using the receiver-operating characteristic curve. Morphological parameters of fusiform aneurysm were extracted based on 3D vessel model. Uni- and multivariate analyses of related predictors for AWE, CRstalk, and FIA types were performed, respectively. Results: Overall, 117 patients (mean age, 53.3 ± 11.7 years; male, 75.2%) with 117 FIAs underwent HR-MRI were included. CRstalk with the maximum signal intensity (CRstalk-max) had the highest sensitivity in identifying symptomatic FIAs with an area under the curve value (0.697) and a cut-off value of 0.90. The independent predictors of AWE were aneurysm symptoms [(odds ratio) OR = 3.754, p = 0.003], aspirin use (OR = 0.248, p = 0.037), and the maximum diameter of the cross-section (OR = 1.171, p = 0.043). The independent predictors of CRstalk-max were aneurysm symptoms (OR = 1.289, p = 0.003) and posterior circulation aneurysm (OR = 1.314, p = 0.001). Transitional-type showed higher rates of hypertension and mural thrombus over both dolichoectatic- and fusiform-type FIAs. Conclusion: CRstalk-max may be the most reliable parameter to quantify AWE to distinguish symptomatic FIAs. It also has the potential to identify unstable FIAs. Several factors contribute to the complex pathophysiology of FIAs and need further validation in a larger cohort.

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Section: Discussionmentioning

confidence: 92%

Quantification of aneurysm wall enhancement in intracranial fusiform aneurysms and related predictors based on high-resolution magnetic resonance imaging: a validation study

Peng

Xia

et al. 2022

Ther Adv Neurol Disord

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“…However, our study lacked an investigation into blood pressure control in hypertensive patients. A previous study showed that patients with IAs could benefit from regular blood pressure monitoring ( 24 ). Studies have shown that with the implementation of community-based hypertension management programs, the majority of Chinese hypertensive patients achieved blood pressure control ( 25 , 26 ).…”

Section: Discussionmentioning

confidence: 99%

Intracranial aneurysm rupture risk in northern China: a retrospective case-control study

Wang,

Zhao,

Zhang

et al. 2024

Quant Imaging Med Surg

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Background Rupture of intracranial aneurysms (IAs) can cause subarachnoid hemorrhage (SAH), which leads to severe neurological dysfunction and even death. Exploring the risk factors for IA rupture and taking preventive measures accordingly can reduce or prevent the occurrence of SAH. Currently, there is still no consensus on the detrimental factors for IA rupture. Thus, our study aimed to investigate the risk factors of IA rupture in a population of northern China. Methods We systematically collected the demographic features, medical history, and imaging data of aneurysms from patients with ruptured and unruptured IAs (UIAs) who attended the Department of Neurosurgery at the Second Hospital of Hebei Medical University from 2014 to 2019. All cases had been diagnosed by digital subtraction angiography. We excluded patients with SAH resulting from injuries, as well as those with vascular dissection and incomplete data. Finally, 1,214 patients including 616 with ruptured IAs and 598 with UIAs were collected for further analysis. A case-control study was conducted, in which multivariable logistic regression was used to analyze the risk factors for IA rupture. Results Our multivariable logistic regression showed that anterior cerebral artery [odds ratio (OR) =2.413; 95% confidence interval (CI): 1.235–4.718], anterior communicating artery (OR =3.952; 95% CI: 2.601–6.006), posterior communicating artery (OR =2.385; 95% CI: 1.790–3.177), and anterior circulation branches (OR =3.493; 95% CI: 1.422–8.581) were risk factors for IA rupture, whereas patients with a history of cerebral infarction (OR =0.395; 95% CI: 0.247–0.631) and those with IAs located in the internal carotid artery (OR =0.403; 95% CI: 0.292–0.557) were less likely to have IA rupture. Conclusions IAs at specific locations are prone to rupture. These IAs should be paid particular attention and preventive measures should be taken to reduce or prevent their rupture.

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“…It may cause de novo aneurysms to appear and existing ones to grow. 1,2 It is thought that adequate antihypertensive treatment to normalize blood pressure could significantly decrease subarachnoid hemorrhage (SAH) risk caused by aneurysm rupture. 3 Some investigators further evaluated the effect of various kinds of antihypertensive drugs (calcium channel blockers (CCB), beta-blockers (BB), angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), or thiazide diuretics) on the incidence of IA or SAH, and found different effects depending on the type of drugs.…”

Section: Introductionmentioning

confidence: 99%

Genetically determined blood pressure, antihypertensive medications, and risk of intracranial aneurysms and aneurysmal subarachnoid hemorrhage: A Mendelian randomization study

Liu,

Zuo,

Johanna

et al. 2023

European Stroke Journal

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Introduction: Observational studies suggest that different classes of antihypertensive drugs may have different effects on the occurrence of intracranial aneurysms (IA) and subarachnoid hemorrhage (SAH). However, the reported results in previous studies are inconsistent, and randomized data are absent. We performed a two-sample Mendelian randomization (MR) analysis to study the causal effects of genetically determined blood pressure (BP) and genetic proxies for antihypertensive drug classes on the risk of IA and SAH. Materials and methods: Genetic instruments and outcome data were obtained from independent genome-wide association studies (GWAS) or published data, which were exclusively restricted to European ancestry. Causal relationships were identified using inverse-variance weighted MR analyses and a series of statistical sensitivity analyses. The FinnGen consortium was used for repeated analysis to verify results obtained from the above GWAS. Results: Two-sample MR analysis showed that genetically determined Systolic BP, Dystolic BP, and Pulse Pressure were related to a higher risk of IA and SAH. Based on identified single nucleotide polymorphisms (SNPs) that influence the effect of calcium channel blockers (CCB, 42 SNPs), beta-blockers (BB, 8 SNPs), angiotensin-converting enzyme inhibitors (ACEI, 2 SNPs), angiotensin receptor blockers (ARB, 1 SNPs), and thiazides (5 SNPs), genetically determined effect of CCBs was associated with a higher risk of IA (OR, 1.07 [95% CI, 1.03–1.10], p = 5.02 × 10−5) and SAH (OR, 1.06 [95% CI, 1.03–1.09], p = 1.84 × 10−3). No associations were found between other antihypertensive drugs and the risk of IA or SAH. The effect of CCBs on SAH was confirmed in FinnGenconsortium samples (OR, 1.04 [95% CI, 1.00–1.08], p = 0.042). Discussion and conclusion: This MR analysis supports the role of elevated blood pressure in the occurrence of intracranial aneurysms and subarachnoid hemorrhage. However, genetic proxies for calcium channel blockers were associated with an increased risk of intracranial aneurysms and subarachnoid hemorrhage. Further studies are required to confirm these findings and investigate the underlying mechanisms.

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Association Between Regular Blood Pressure Monitoring and the Risk of Intracranial Aneurysm Rupture: a Multicenter Retrospective Study with Propensity Score Matching

Cited by 10 publications

References 39 publications

Quantification of aneurysm wall enhancement in intracranial fusiform aneurysms and related predictors based on high-resolution magnetic resonance imaging: a validation study

Quantification of aneurysm wall enhancement in intracranial fusiform aneurysms and related predictors based on high-resolution magnetic resonance imaging: a validation study

Intracranial aneurysm rupture risk in northern China: a retrospective case-control study

Genetically determined blood pressure, antihypertensive medications, and risk of intracranial aneurysms and aneurysmal subarachnoid hemorrhage: A Mendelian randomization study

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