title: Effects of Induced Hypertension on Cerebral Perfusion in Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage: A Randomized Clinical Trial.
abstract: OBJECTIVE
  The presumed effectiveness of induced hypertension for treating delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage is based on uncontrolled case-series only. We assessed the effect of induced hypertension on cerebral blood flow (CBF) in aneurysmal subarachnoid hemorrhage patients with delayed cerebral ischemia in a randomized clinical trial.
  
  
  METHODS
  Aneurysmal subarachnoid hemorrhage patients were randomized to induced or no induced hypertension (control group) at delayed cerebral ischemia onset. CBF was assessed, blinded for treatment allocation, with computed tomographic perfusion in standardized predefined regions at delayed cerebral ischemia onset and after 24 to 36 hours of study treatment. Mean arterial blood pressure was compared between groups (linear mixed model). The primary outcome measure was the difference in change in overall CBF (Mann-Whitney U test).
  
  
  RESULTS
  Mean arterial blood pressure was, on average, 12 mm Hg (95% confidence interval, 8.6-14.5) higher in the hypertension group (n=12) than in the control group (n=13). Change in overall CBF (mL/100g per s) was -8.5 (range, -42 to 30) in the control group and 0.1 (range, -31-43) in the hypertension group (P=0.25).
  
  
  CONCLUSIONS
  Change in overall CBF did not differ to a statistically significant extent between the groups. Based on our results, 225 to 250 patients per group are needed to find a statistically significant difference in change in overall CBF between induced hypertension and no hypertension.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT0161323.
authors.affiliation: From the Departments of Intensive Care Medicine (C.S.G., A.J.C.S.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (C.S.G., B.H.V., G.J.E.R.), and Department of Radiology (J.W.D.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Intensive Care, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands (M.v.d.J.); Department of Intensive Care, St. Elisabeth Hospital Tilburg, Tilburg, The Netherlands (A.W.O.); and Department of Critical Care, University Medical Center Groningen, Groningen, The Netherlands (W.M.v.d.B.). c.s.gathier-2@umcutrecht.nl.
authors.forename: Celine S
authors.initials: CS
authors.lastname: Gathier
authors.affiliation: From the Departments of Intensive Care Medicine (C.S.G., A.J.C.S.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (C.S.G., B.H.V., G.J.E.R.), and Department of Radiology (J.W.D.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Intensive Care, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands (M.v.d.J.); Department of Intensive Care, St. Elisabeth Hospital Tilburg, Tilburg, The Netherlands (A.W.O.); and Department of Critical Care, University Medical Center Groningen, Groningen, The Netherlands (W.M.v.d.B.).
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Dankbaar
authors.affiliation: From the Departments of Intensive Care Medicine (C.S.G., A.J.C.S.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (C.S.G., B.H.V., G.J.E.R.), and Department of Radiology (J.W.D.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Intensive Care, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands (M.v.d.J.); Department of Intensive Care, St. Elisabeth Hospital Tilburg, Tilburg, The Netherlands (A.W.O.); and Department of Critical Care, University Medical Center Groningen, Groningen, The Netherlands (W.M.v.d.B.).
authors.forename: Mathieu
authors.initials: M
authors.lastname: van der Jagt
authors.affiliation: From the Departments of Intensive Care Medicine (C.S.G., A.J.C.S.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (C.S.G., B.H.V., G.J.E.R.), and Department of Radiology (J.W.D.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Intensive Care, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands (M.v.d.J.); Department of Intensive Care, St. Elisabeth Hospital Tilburg, Tilburg, The Netherlands (A.W.O.); and Department of Critical Care, University Medical Center Groningen, Groningen, The Netherlands (W.M.v.d.B.).
authors.forename: Bon H
authors.initials: BH
authors.lastname: Verweij
authors.affiliation: From the Departments of Intensive Care Medicine (C.S.G., A.J.C.S.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (C.S.G., B.H.V., G.J.E.R.), and Department of Radiology (J.W.D.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Intensive Care, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands (M.v.d.J.); Department of Intensive Care, St. Elisabeth Hospital Tilburg, Tilburg, The Netherlands (A.W.O.); and Department of Critical Care, University Medical Center Groningen, Groningen, The Netherlands (W.M.v.d.B.).
authors.forename: Annemarie W
authors.initials: AW
authors.lastname: Oldenbeuving
authors.affiliation: From the Departments of Intensive Care Medicine (C.S.G., A.J.C.S.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (C.S.G., B.H.V., G.J.E.R.), and Department of Radiology (J.W.D.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Intensive Care, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands (M.v.d.J.); Department of Intensive Care, St. Elisabeth Hospital Tilburg, Tilburg, The Netherlands (A.W.O.); and Department of Critical Care, University Medical Center Groningen, Groningen, The Netherlands (W.M.v.d.B.).
authors.forename: Gabriel J E
authors.initials: GJ
authors.lastname: Rinkel
authors.affiliation: From the Departments of Intensive Care Medicine (C.S.G., A.J.C.S.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (C.S.G., B.H.V., G.J.E.R.), and Department of Radiology (J.W.D.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Intensive Care, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands (M.v.d.J.); Department of Intensive Care, St. Elisabeth Hospital Tilburg, Tilburg, The Netherlands (A.W.O.); and Department of Critical Care, University Medical Center Groningen, Groningen, The Netherlands (W.M.v.d.B.).
authors.forename: Walter M
authors.initials: WM
authors.lastname: van den Bergh
authors.affiliation: From the Departments of Intensive Care Medicine (C.S.G., A.J.C.S.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (C.S.G., B.H.V., G.J.E.R.), and Department of Radiology (J.W.D.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Intensive Care, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands (M.v.d.J.); Department of Intensive Care, St. Elisabeth Hospital Tilburg, Tilburg, The Netherlands (A.W.O.); and Department of Critical Care, University Medical Center Groningen, Groningen, The Netherlands (W.M.v.d.B.).
authors.forename: Arjen J C
authors.initials: AJ
authors.lastname: Slooter
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications; D062186:Arterial Pressure; D002545:Brain Ischemia / Q000188:drug therapy* / Q000209:etiology; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D006973:Hypertension / Q000139:chemically induced*; D002532:Intracranial Aneurysm / Q000150:complications; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use*; D013345:Subarachnoid Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D009638:Norepinephrine
keywords: arterial pressure; cerebral infarction; hypertension; randomized controlled trial; subarachnoid hemorrhage