Is hypertension a major risk factor in aneurysmal subarachnoid hemorrhage?
OBJECTIVE
The role of hypertension as a major risk factor for the development and rupture of cerebral aneurysms is a subject of considerable debate.


METHODS
In order to substantiate or weaken the hypothesis of the atherogenic, degenerative origin of this disease, in addition to hypertension the influence of smoking and the covariates body weight, hematocrit, fibrinogen and leukocrit were examined in a hospital-based case-control and cohort study. 141 consecutive patients with subarachnoid hemorrhage (SAH) and verified cerebral aneurysms, admitted between September 1994 and August 1998, were investigated.


RESULTS
An association was found between hypertension and SAH of cerebral aneurysm in the entire patient group (P < 0.0001). In the stepwise logistic regression, the exposure odds ratio (OR) for hypertension was 6.8 (CI (95%): 3.53-13.14). Smokers have a twofold higher risk, with an OR of 2.2 (CI (95%): 1.19-4.06). Age was found to have a prognostic impact on the disease (P = 0.0089). Age obviously was a confounding factor for hypertension, which was associated with the outcome (P = 0.048).


CONCLUSIONS
Patients with hypertension had a nearly seven-fold higher risk of aneurysmal subarchnoid hemorrhage. This seems to substantiate the hypothesis that aneurysm is an acquired and hemodynamically induced chronic disease.
Kleinpeter
Güther
G
Neurochirurgische Abteilung, Donauspital, Wien, Austria. g.kleinpeter@billrothhaus.at
Lehr
Stephan
S
D000368:Aged; D017542:Aneurysm, Ruptured / Q000209:etiology*; D001317:Austria; D001835:Body Weight; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006400:Hematocrit; D006801:Humans; D006973:Hypertension / Q000150:complications*; D002532:Intracranial Aneurysm / Q000150:complications*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013345:Subarachnoid Hemorrhage / Q000209:etiology*
D005340:Fibrinogen