Hypertension and smoking increase the risk of brain hemorrhage



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Blood pressure and smoking seem to significantly affect the risk of brain bleeding

A recent study by German and Dutch researchers provides evidence for a relationship between the occurrence of aneurysmal brain hemorrhage and risk factors for hypertension and smoking.

Risk factors for hypertension and smoking

In a recent study by German and Dutch scientists, evidence was found to show an association between the occurrence of aneurysmal brain bleeding and risk factors for hypertension and smoking. A comprehensive meta-analysis was published in the journal "JAMA Neurology" by researchers from the Department of Neurosurgery at the University Medical Center Mannheim (UMM) in collaboration with scientists from the Department of Neurology, Utrecht University, Netherlands.

In a recently published meta-analysis, there are clear indications of the relationship between the occurrence of aneurysmal brain bleeding and risk factors for hypertension and smoking. (Image: peterschreiber.media/fotolia.com)

Special form of stroke

Aneurysmal subarachnoid hemorrhage (SAB) is a special form of stroke in which blood enters the subarachnoid space which is filled with cerebrospinal fluid, protecting the brain and spinal cord.

As explained in a statement by UMM, this type of cerebral hemorrhage often occurs when an aneurysm, a saccular extension of the artery, ruptures at the base of the brain.

Although subarachnoid bleeding only accounts for about five percent of all strokes, the consequences are very threatening:

Half of those affected were younger than 55, one third died within the first few days until the week after the onset of bleeding, and about one third of survivors were permanently dependent on aid.

Meta-analyzes of German and Dutch scientists now reveal for the first time a worldwide decline in the incidence of parallel aneurysm-related cerebral hemorrhages with decreased hypertension and smoking.

The aim of the researchers was not only to explain the seemingly heterogeneous temporal and spatial distribution of SAB events, but also to identify potential determinants that could be responsible for the decline in this disease.

The number of diseases decreases

The starting point of this project was recently published, sometimes conflicting data from various register-based or regional studies, which documented a decrease in the incidence of subarachnoid hemorrhage.

Systematic reviews include the metadata of all global population-based stroke studies over the past 60 years. On the one hand, this study captures the occurrence of regional aneurysmal hemorrhage and their frequency over time.

In addition, the meta-analysis presents the first time the development of blood pressure and smoking factors in relation to the incidence of SAB.

There are clear indications about the relationship between the occurrence of aneurysmal brain bleeding and risk factors for hypertension and smoking.

In particular, analysis of data from 75 studies involving more than 8,000 people from 32 countries showed that the incidence of cerebral hemorrhage has declined significantly in the last few decades:

Between 1980 and 2010, the global incidence of subarachnoid aneurysmal hemorrhage decreased by about 40 percent. Here, however, a large regional difference is detected:

European incidents fell 41 percent, in Asia 46 percent and in North America 14 percent. In contrast, the incidence of SAB in Japan has increased 59 percent in the past three decades. SAB incidents are also distributed differently according to age and gender.

Reducing in parallel with a decrease in systolic blood pressure and the prevalence of smoking

It is very surprising that the development or decrease in the incidence of SAB around the world parallels the decrease in systolic blood pressure and the prevalence of smoking during the same period.

"Mind games: If the decrease in the actual incidence of SAB is directly related to a decrease in systolic blood pressure, this means that SAB incidents will decrease by 7.1 percent with every drop in blood pressure of 1 mmHg," explained the lead author of the scientific publication, Professor Nima Etminan.

"And in terms of smoking prevalence, this means that SAB incidents decreased by 2.4 percent per decline in the prevalence of smoking," said the head of the doctor's UMM Neurosurgery Department.

Of course, the parallel development of hypotension and the prevalence of smoking with the incidence of subarachnoid hemorrhage only show a causal relationship.

Existing data cannot provide evidence about this, because quantitative data for these risk factors based on population or at individual patient level will be needed.

However, the association found in this study supports a preventative approach to control risk factors for hypertension and smoking to reduce the risk of aneurysmal brain bleeding.

Reduces the risk of aneurysmal brain bleeding

At the same time, the authors are currently investigating the scientific question, whether lowering blood pressure in patients with aneurysms found randomly, who are not primarily treated but controlled by imaging, has a beneficial effect on the development of aneurysms.

This is part of a prospective phase III PROTECT-U study (www.protect-u-trial.com/) in various neurovascular centers in Germany, the Netherlands and soon also in Canada.

This work also provides a starting point for further study, which results, if they lead to the right primary prevention strategy, can actually help further reduce the risk of aneurysmal brain bleeding:

This will be a closer examination of regional differences in SAB events and their reduction, regional differences in age and gender-related incidents, and their relationship with more accurate quantitative data about smoking behavior. (Ad)

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