Hypertension predisposes to the formation of saccular intracranial aneurysms in 467 unruptured and 1053 ruptured patients in Eastern Finland

Abstract

Objective. Hypertension associates with subarachnoid hemorrhage from saccular intracranial aneurysm (sIA-SAH) when compared to matched controls or general population. Few series compare hypertension in unruptured sIA versus sIA-SAH, so its impact on the sIA disease remains uncertain.

Methods. Kuopio sIA Database (www.uef.fi/ns) contains all cases of unruptured and ruptured sIAs admitted to Kuopio University Hospital from its Eastern Finnish catchment population. We compared the age-adjusted incidence of drug-treated hypertension in 467 unruptured and 1053 ruptured sIA patients admitted to Kuopio University Hospital from 1995 to 2007, using the national registry of prescribed medicines.

Results. Antihypertensive medication was more frequent in the unruptured (73% versus 62%) with higher age-adjusted incidence. At sIA diagnosis, the sIA-SAH group had more often untreated hypertension (29% versus 23%). The size of unruptured sIAs increased with age at sIA diagnosis, independently of hypertension. Multiple sIAs, familial sIA, and sIA-SAH were not associated with hypertension in multivariate analysis. Results indicate that drug-treated hypertension associates with the formation of sIAs rather than their growth or rupture.

Conclusion. Hypertension is highly prevalent in the carriers of unruptured sIAs when compared to those with ruptured sIA. Hypertension may associate with the sIA formation, and may predispose to the rupture of sIA if untreated.

Key words::

• Hypertension
• intracranial aneurysm
• subarachnoid hemorrhage

Acknowledgements

J.E.J. and M.v.u.z.F. jointly directed this work. A.L. collected and analyzed data, wrote manuscript; M.K. analyzed data, edited manuscript. A.Ri. collected data. T.K. collected data, edited manuscript. A.Ro. collected data, edited manuscript. J.R. collected data, edited manuscript. J.H. collected data, edited manuscript. J.G.E edited manuscript. J.E.J. analyzed data, edited manuscript. M.v.u.z.F. analyzed data, edited manuscript. We thank Associate Professor Seppo Juvela for valuable comments.

Declaration of interest: The authors report no conflicts of interest. This research was funded by the University of Eastern Finland, EVO funding of Kuopio University Hospital, Sakari Sohlberg foundation, North Savo Regional Fund of Finnish Cultural Foundation, and Emil Aaltonen Foundation.