Risk of subarachnoid haemorrhage reduces with blood pressure values below hypertensive thresholds
Risk of subarachnoid haemorrhage reduces with blood pressure values below hypertensive thresholds
BACKGROUND: hypertension is a known risk factor for subarachnoid haemorrhage (SAH). The aim of this study was to describe the relationship between blood pressure and SAH using a large cohort study and perform a meta-analysis of the published literature.
METHODS: participants in the UK Biobank were followed up via electronic records until 31 March 2017. Cox proportional hazards models were used to analyse the association between baseline blood pressure (systolic blood pressure [SBP], diastolic blood pressure [DBP] and MABP [mean arterial blood pressure]) and subsequent aneurysmal SAH. Linearity was assessed by comparing models including and excluding cubic splines. Electronic databases were searched from inception until 11 February 2022 for studies reporting on blood pressure and SAH.
RESULTS: a total of 500,598 individuals were included with 539 (0.001%) suffering from aneurysmal SAH. Nonlinear models including cubic splines visually appeared linear between SBP of 110 and 180 mmHg and there was minimal difference in fit between linear and nonlinear models. When values were stratified, those with SBP 120-130 mmHg were at higher risk compared to those with SBP <120 mmHg (hazard ratio [HR] 1.41 [1.02, 1.95]). The meta-analysis demonstrated a similar increased risk of SAH in individuals with SBP 120-130 mmHg relative to those with <120 mmHg (HR 1.41 [1.17, 1.72]). A stepwise increase in risk was also seen at each subsequent threshold (130-140 mmHg: HR 1.85 [1.53, 2.24], 140-160 mmHg: HR 2.16 [1.57, 2.98], 160-180 mmHg: HR 2.81 [1.85, 4.29], >180 mmHg: HR 5.84 [1.94, 17.54]).
CONCLUSIONS: the rate of SAH increases linearly with higher SBP in the general population and specifically appears lower in those with SBP <120 mmHg.
blood pressure, hypertension, stroke, subarachnoid haemorrhage
Ewbank, Frederick
70a00611-6654-4016-9be7-cd7bbc9d4a4d
Gaastra, Benjamin
c7b7f371-706b-4d59-9150-94e8f254e205
Hall, Samuel
703c2f84-ad99-4211-9408-307bbb59732c
Galea, Ian
66209a2f-f7e6-4d63-afe4-e9299f156f0b
Bulters, Diederik
d6f9644a-a32f-45d8-b5ed-be54486ec21d
January 2024
Ewbank, Frederick
70a00611-6654-4016-9be7-cd7bbc9d4a4d
Gaastra, Benjamin
c7b7f371-706b-4d59-9150-94e8f254e205
Hall, Samuel
703c2f84-ad99-4211-9408-307bbb59732c
Galea, Ian
66209a2f-f7e6-4d63-afe4-e9299f156f0b
Bulters, Diederik
d6f9644a-a32f-45d8-b5ed-be54486ec21d
Ewbank, Frederick, Gaastra, Benjamin, Hall, Samuel, Galea, Ian and Bulters, Diederik
(2024)
Risk of subarachnoid haemorrhage reduces with blood pressure values below hypertensive thresholds.
European Journal of Neurology, 31 (1), [e16105].
(doi:10.1111/ene.16105).
Abstract
BACKGROUND: hypertension is a known risk factor for subarachnoid haemorrhage (SAH). The aim of this study was to describe the relationship between blood pressure and SAH using a large cohort study and perform a meta-analysis of the published literature.
METHODS: participants in the UK Biobank were followed up via electronic records until 31 March 2017. Cox proportional hazards models were used to analyse the association between baseline blood pressure (systolic blood pressure [SBP], diastolic blood pressure [DBP] and MABP [mean arterial blood pressure]) and subsequent aneurysmal SAH. Linearity was assessed by comparing models including and excluding cubic splines. Electronic databases were searched from inception until 11 February 2022 for studies reporting on blood pressure and SAH.
RESULTS: a total of 500,598 individuals were included with 539 (0.001%) suffering from aneurysmal SAH. Nonlinear models including cubic splines visually appeared linear between SBP of 110 and 180 mmHg and there was minimal difference in fit between linear and nonlinear models. When values were stratified, those with SBP 120-130 mmHg were at higher risk compared to those with SBP <120 mmHg (hazard ratio [HR] 1.41 [1.02, 1.95]). The meta-analysis demonstrated a similar increased risk of SAH in individuals with SBP 120-130 mmHg relative to those with <120 mmHg (HR 1.41 [1.17, 1.72]). A stepwise increase in risk was also seen at each subsequent threshold (130-140 mmHg: HR 1.85 [1.53, 2.24], 140-160 mmHg: HR 2.16 [1.57, 2.98], 160-180 mmHg: HR 2.81 [1.85, 4.29], >180 mmHg: HR 5.84 [1.94, 17.54]).
CONCLUSIONS: the rate of SAH increases linearly with higher SBP in the general population and specifically appears lower in those with SBP <120 mmHg.
Text
Euro J of Neurology - 2023 - Ewbank - Risk of subarachnoid haemorrhage reduces with blood pressure values below
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Accepted/In Press date: 2 October 2023
e-pub ahead of print date: 25 October 2023
Published date: January 2024
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Funding Information:
No acknowledgments to declare.
Publisher Copyright:
© 2023 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
Keywords:
blood pressure, hypertension, stroke, subarachnoid haemorrhage
Identifiers
Local EPrints ID: 483268
URI: http://eprints.soton.ac.uk/id/eprint/483268
ISSN: 1351-5101
PURE UUID: 08bc7e44-e7fe-46b6-81f8-2ee9121389d2
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Date deposited: 27 Oct 2023 16:31
Last modified: 18 Mar 2024 04:02
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Author:
Frederick Ewbank
Author:
Samuel Hall
Author:
Diederik Bulters
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