Does Nimodipine eliminate arterial hypertension as a prognostic risk factor in subarachnoid haemorrhage?

Abstract

Several studies have demonstrated an association between arterial hypertension (AH) and an increased morbidity and mortality from both cardiovascular diseases and stroke (including subarachnoid haemorrhage, SAH). Among the functional disturbances implicated in hypertension much interest has been focused on the calcium handling in the vascular smooth muscle cells, and it has been proposed that a defect in the calcium gating mechanisms in the cell membrane is of major importance. Clinical trials have confirmed that calcium antagonists of the dihydropyridine type (nimodipine) are useful in preventing secondary ischaemia after SAH. The purpose of this retrospective study was to determine if the protective effect of nimodipine differs between normotensive and hypertensive patients focused on delayed ischaemia, total morbidity and mortality. In the group (137 patients) without nimodipine treatment 17 out of 31 individuals (55%) with AH had an unfavourable outcome. In the nimodipine group (also 137 patients) four out of 25 individuals (16%) with AH had an unfavourable outcome. In terms of vasospasm and delayed ischaemia only, the difference was even more evident. These results indicate that nimodipine seems to significantly reduce the prognostic difference between normo- and hypertensive individuals with an aneurysmal SAH.

Key Words:

• Arterial hypertension
• subarachnoid haemorrhage
• nimodipine
• delayed ischaemia
• outcome