Article Figures & Data
- Figure 1
Flow diagram delineating how the study population was derived from the source population. A total of 10 817 patients with intracranial aneurysms were reviewed initially. Finally, a total of 4545 patients with aneurysmal subarachnoid haemorrhage (aSAH) were enrolled in this study, of whom 1959 patients (43.10%) had premorbid hypertension. During the step 2 analysis, 1238 patients with hypertension with aSAH, including 290 renin-angiotensin-aldosterone system (RAAS) inhibitor users (23.42%) and 948 non-RAAS inhibitor users (76.58%), were included.
- Figure 2
Interaction and subgroup analyses for the treatment effect of renin-angiotensin-aldosterone (RAAS) inhibitors on the severity of aneurysmal subarachnoid haemorrhage (aSAH). The beneficial impacts of RAAS inhibitors on Hunt-Hess scale (A) and World Federation of Neurological Surgeons (WFNS) scale (B) were notably pronounced within the subgroup characterised by controlled hypertension, combination therapy and irregular aneurysms. Particularly, the results of the interaction test revealed that hypertension control and age exhibited a significant interaction effect with the use of RAAS inhibitors on outcomes. ‘posterior’ denotes posterior circulation (including the vertebral artery, basilar artery, cerebellar arteries and posterior cerebral artery). ACA, anterior cerebral arteries (including the anterior cerebral artery, anterior communicating artery and pericallosal artery); BMI, body mass index; ICA, internal carotid artery; MCA, middle cerebral artery; PCoA, posterior communicating artery; PLT, platelet.
- Table 1
Impact of preadmission hypertension statuses on the two poor clinical grading scales of aSAH
Outcomes Exposures (n) Poor outcomes, n (%) Multivariable model* Imputed data (n=4545) Complete data (n=2925) OR (95% CI) P value OR (95% CI) P value Hunt-Hess scale
(1–3 vs 4–5)Non-hypertension (2586) 263 (10.2) Reference Reference Hypertension (1959) 291 (14.9) 1.319 (1.093 to 1.592) 0.004 1.244 (0.997 to 1.553) 0.053 Controlled hypertension (554) 70 (12.6) 1.070 (0.800 to 1.432) 0.648 1.072 (0.768 to 1.495) 0.683 Uncontrolled hypertension (687) 133 (19.4) 1.799 (1.413 to 2.291) 0.000 1.666 (1.261 to 2.201) 0.000 Unmonitored hypertension (718) 88 (12.3) 1.100 (0.844 to 1.434) 0.479 0.972 (0.700 to 1.348) 0.863 WFNS scale
(1–3 vs 4–5)Non-hypertension (2586) 598 (23.1) Reference Reference Hypertension (1959) 586 (29.9) 1.256 (1.092 to 1.446) 0.001 1.273 (1.070 to 1.513) 0.006 Controlled hypertension (554) 131 (23.6) 0.891 (0.713 to 1.114) 0.313 0.844 (0.642 to 1.110) 0.224 Uncontrolled hypertension (687) 258 (37.6) 1.721 (1.425 to 2.079) 0.000 1.907 (1.525 to 2.385) 0.000 Unmonitored hypertension (718) 197 (27.4) 1.175 (0.969 to 1.426) 0.101 1.085 (0.846 to 1.391) 0.522 *Multivariable model adjusted for age, sex, ethnicity, body mass index, smoking status, controlled status of hypertension, ischaemic stroke, preadmission use of anti-platelet medication, preadmission use of anticoagulation medication, location of the reputed aneurysm, size of the aneurysm, shape irregularity of the aneurysm and number of intracranial aneurysms.
aSAH, aneurysmal subarachnoid haemorrhage; WFNS, World Federation of Neurological Surgeons.
- Table 2
Treatment effect of RAAS inhibitors on the two poor clinical grading scales of aSAH
Outcomes Exposures (n) Poor outcomes, n (%) Multivariable model* Imputed data (n=1238) Complete data (n=806) OR (95% CI) P value OR (95% CI) P value Hunt-Hess scale
(1–3 vs 4–5)Non-RAAS inhibitors (948) 158 (16.7) Reference Reference RAAS inhibitors (290) 43 (14.8) 0.653 (0.430 to 0.992) 0.046 0.558 (0.340 to 0.918) 0.022 WFNS scale
(1–3 vs 4–5)Non-RAAS inhibitors (948) 298 (31.4) Reference Reference RAAS inhibitors (290) 84 (29.0) 0.656 (0.469 to 0.918) 0.014 0.587 (0.391 to 0.882) 0.010 *Multivariable model adjusted for age, sex, ethnicity, body mass index, smoking status, controlled status of hypertension, number of antihypertensive medications, ischaemic stroke, preadmission use of anti-platelet medication, preadmission use of anticoagulation medications, location of the reputed aneurysm, size of the aneurysm, shape irregularity of the aneurysm and number of intracranial aneurysms.
aSAH, aneurysmal subarachnoid haemorrhage; RAAS, renin-angiotensin-aldosterone system; WFNS, World Federation of Neurological Surgeons.
Supplementary Materials
Supplementary data
Additional Files
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
