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Possible association between the blood pressure increase and the risk of delayed cerebral ischemia (DCI) and different systemic complications after aSAH is still a matter of debate. This study aims to elucidate the influence of blood pressure levels on the outcome of aSAH. All consecutive aSAH patients (n\u2009=\u2009690) treated between 01\/2003 and 06\/2016 were included. The mean value of the mean arterial pressure (MAP) during 14\u00a0days after ictus was calculated for each individual. According to the institutional standards of vasospasm management, the mean 14\u00a0days MAP\u2009\u2265\u200995\u00a0mmHg was referred as increased (IMAP) and the patients with and without vasospasm were analyzed separately. Study endpoints were the occurrence of DCI on computed tomography scans, development of cardiac and nephrological complications, and poor outcome 6\u00a0months after aSAH (mRS\u2009&gt;\u20092). Associations were tested in univariable\/multivariable binary logistic regression analysis. IMAP was documented in 474 (68.7%) cases and was more common in individuals with poor neurological conditions at admission (p\u2009&lt;\u20090.001), severe amount of intracranial blood (p\u2009=\u20090.001) and premorbid hypertension (p\u2009&lt;\u20090.001). IMAP was independently associated with the occurrence of DCI (p\u2009=\u20090.014; aOR\u2009=\u20092.97; 95% CI 1.25\u20137.09) and poor functional outcome (p\u2009=\u20090.020; aOR\u2009=\u20093.14; 95% CI 1.20\u20138.22) in patients with vasospasm, but not in counterparts without vasospasm (p\u2009=\u20090.113\/p\u2009=\u20090.086). IMAP had no influence on cardiac or nephrological complications. In aSAH individuals with cerebral vasospasm, sustained increase of blood pressure exceeding the therapeutic targets is strongly associated with the risk of DCI and poor outcome. Therefore, such an intrinsic increase of blood pressure might reflect the autoregulatory mechanisms against the impending cerebral ischemia in patients with cerebral vasospasm.<\/jats:p><jats:p>Trial registration number: German clinical trial registry (DRKS, Unique identifier: DRKS00008749, 06\/09\/2015).<\/jats:p>","DOI":"10.1038\/s41598-022-11903-4","type":"journal-article","created":{"date-parts":[[2022,5,14]],"date-time":"2022-05-14T10:16:06Z","timestamp":1652523366000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Blood pressure and outcome after aneurysmal subarachnoid hemorrhage"],"prefix":"10.1038","volume":"12","clinical-trial-number":[{"clinical-trial-number":"drks00008749","registry":"10.18810\/drks"}],"author":[{"given":"Marvin","family":"Darkwah Oppong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Steinwasser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Rie\u00df","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karsten H.","family":"Wrede","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thiemo F.","family":"Dinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yahya","family":"Ahmadipour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Dammann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laur\u00e8l","family":"Rauschenbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meltem","family":"G\u00fcm\u00fcs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelius","family":"Deuschl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"Sure","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramazan","family":"Jabbarli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,5,14]]},"reference":[{"key":"11903_CR1","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.0000000000007862","author":"R Jabbarli","year":"2019","unstructured":"Jabbarli, R. et al. Endovascular treatment of cerebral vasospasm after subarachnoid hemorrhage: More is more. Neurology https:\/\/doi.org\/10.1212\/wnl.0000000000007862 (2019).","journal-title":"Neurology"},{"issue":"12","key":"11903_CR2","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1007\/s11883-017-0690-x","volume":"19","author":"JR Geraghty","year":"2017","unstructured":"Geraghty, J. R. & Testai, F. D. Delayed cerebral ischemia after subarachnoid hemorrhage: Beyond vasospasm and towards a multifactorial pathophysiology. Curr. Atheroscler. Rep. 19(12), 50. https:\/\/doi.org\/10.1007\/s11883-017-0690-x (2017).","journal-title":"Curr. Atheroscler. Rep."},{"issue":"6","key":"11903_CR3","doi-asserted-by":"publisher","first-page":"1711","DOI":"10.1161\/STR.0b013e3182587839","volume":"43","author":"ES Connolly Jr","year":"2012","unstructured":"Connolly, E. S. Jr. et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: A guideline for healthcare professionals from the American Heart Association\/American Stroke Association. Stroke 43(6), 1711\u20131737. https:\/\/doi.org\/10.1161\/STR.0b013e3182587839 (2012).","journal-title":"Stroke"},{"issue":"2","key":"11903_CR4","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1159\/000346087","volume":"35","author":"T Steiner","year":"2013","unstructured":"Steiner, T. et al. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc. Dis. (Basel, Switzerland) 35(2), 93\u2013112. https:\/\/doi.org\/10.1159\/000346087 (2013).","journal-title":"Cerebrovasc. Dis. (Basel, Switzerland)"},{"issue":"10","key":"11903_CR5","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1016\/s1474-4422(03)00531-3","volume":"2","author":"J Sen","year":"2003","unstructured":"Sen, J. et al. Triple-H therapy in the management of aneurysmal subarachnoid haemorrhage. Lancet Neurol. 2(10), 614\u2013621. https:\/\/doi.org\/10.1016\/s1474-4422(03)00531-3 (2003).","journal-title":"Lancet Neurol."},{"issue":"1","key":"11903_CR6","doi-asserted-by":"publisher","first-page":"R23","DOI":"10.1186\/cc8886","volume":"14","author":"JW Dankbaar","year":"2010","unstructured":"Dankbaar, J. W., Slooter, A. J., Rinkel, G. J. & Schaaf, I. C. Effect of different components of triple-H therapy on cerebral perfusion in patients with aneurysmal subarachnoid haemorrhage: A systematic review. Crit. Care (London, England) 14(1), R23. https:\/\/doi.org\/10.1186\/cc8886 (2010).","journal-title":"Crit. Care (London, England)"},{"issue":"11","key":"11903_CR7","doi-asserted-by":"publisher","first-page":"3277","DOI":"10.1161\/strokeaha.115.010537","volume":"46","author":"CS Gathier","year":"2015","unstructured":"Gathier, C. S. et al. 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