title: Antihypertensives are administered selectively in emergency department patients with subarachnoid hemorrhage.
abstract: Elevated blood pressure is common in patients with acute subarachnoid hemorrhage (SAH). American Heart Association guidelines do not specify a blood pressure target, but limited data suggest that systolic blood pressure (SBP)≥160 mmHg is associated with increased risk of rebleeding and neurologic decline. In a population-based study, we determined the frequency of antihypertensive therapy in emergency department (ED) patients with SAH and the proportion of those patients with SBP≥160 mmHg who received this therapy. In 2005, nontraumatic SAH cases were retrospectively ascertained at 16 hospitals in our region by screening for International Classification of Diseases Ninth Revision diagnostic codes 430-436. Blood pressure was recorded at ED presentation and also before and after any treatment with antihypertensives. Hypotension was defined as SBP<100 mmHg. The Mann-Whitney U test and χ2 test were used for comparisons. Our cohort comprised 82 patients with SAH presenting to an ED; 4 patients were excluded. The median age of the included patients was 54 years, 74.4% were female, 29.5% were black, and 31 (39.7%) had SBP≥160 mmHg. Antihypertensive therapy was given to 22 of 31 patients (70.9%) with SBP≥160 mmHg and to 4 of 47 patients (8.5%) with SBP<160 mmHg. No patients became hypotensive after receiving treatment. Age, sex, Glascow Coma Scale score, and National Institutes of Health Stroke Scale score were similar between treated and untreated patients. In the absence of definitive evidence, current blood pressure management in local EDs appears reasonable. Further studies of blood pressure management in acute SAH are warranted.
authors.affiliation: Department of Emergency Medicine, University of Cincinnati Neuroscience Institute, University of Cincinnati, Cincinnati, Ohio. Electronic address: culyerva@ucmail.uc.edu.
authors.forename: Virginia
authors.initials: V
authors.lastname: Culyer
authors.forename: Erin
authors.initials: E
authors.lastname: McDonough
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lindsell
authors.forename: Kathleen
authors.initials: K
authors.lastname: Alwell
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Moomaw
authors.forename: Brett M
authors.initials: BM
authors.lastname: Kissela
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Flaherty
authors.forename: Pooja
authors.initials: P
authors.lastname: Khatri
authors.forename: Daniel
authors.initials: D
authors.lastname: Woo
authors.forename: Simona
authors.initials: S
authors.lastname: Ferioli
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Broderick
authors.forename: Dawn
authors.initials: D
authors.lastname: Kleindorfer
authors.forename: Opeolu
authors.initials: O
authors.lastname: Adeoye
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology; D002648:Child; D004363:Drug Utilization; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents