Background and Purpose-From the studied variables in subarachnoid hemorrhage (SAH) risk, hypertension is probably the most controvertible one. The aim of this study was to determine whether confirmed hypertension, prospectively diagnosed with strict criteria, is an independent risk factor for aneurysmal SAH. Methods-A case-control study was conducted in 2 colombian cities between July 2004 and June 2005. There were 163 new cases of SAH (mean age 51 years; 107 were women) with 2 controls per case: 1 hospital and 1 community control. Hypertension was defined according to cardiovascular criteria, based on target organ damage. In addition to hypertension, other variables were studied: present smoking, recent alcohol consumption, alcohol dependency, coffee consumption, cocaine use, and body mass index. A multivariate logistic regression model was used to determine whether hypertension was an independent risk factor. Results-Among the studied variables, including confirmed hypertension, only present smoking became an independent risk factor for SAH. Conclusions-Confirmed hypertension is not an independent risk factor for aneurysmal SAH. Key Words: subarachnoid hemorrhage Ⅲ risk factors Ⅲ aneurysm Ⅲ hypertension Ⅲ cigarette smoking I nitial bleeding impact accounts for most deaths in aneurysmal subarachnoid hemorrhage (SAH); mortality could decrease if incidence rate is reduced, and then it is necessary to identify risk factors, of which only cigarette smoking is indisputable. All other variables, including hypertension, are still subject to debates. [1][2][3] The study of hypertension in SAH is problematic as patients, because of Cushing reflex, frequently show elevated blood pressure, irrespective of being or not hypertensive. 4 The aim of this study was to determine whether confirmed hypertension, prospectively diagnosed with target organ damage criteria, is an independent risk factor for SAH.
Subjects and MethodsA case-control study with incident SAH cases was performed, with patients hospitalized in San Vicente de Paul Hospital, Hospital General, and Clinica Leon XIII from Medellin, or in Hospital Evaristo Moreno from Cali (Colombia). Two controls per case were selected: 1 hospital and 1 community control. Hospitalized controls were patients with nontraumatic acute abdomen (appendicitis, cholecystitis, among others) and community controls were cases' friends. Sampling size was calculated to detect an Odds Ratio of 2.0, with an expected proportion of 15.7% of hypertension among controls, and a case-control ratio of 1:2; thus, 159 cases and 318 controls were included. The studied variables were: SAH (independent), cigarette smoking (in addition with the 6-item Fagerstrom test for nicotine dependence, with a 0 to 10 score), 5 recent alcohol consumption, alcohol dependency according to CAGE questionnaire, 2 confirmed hypertension (fulfilling 1 of these criteria: antihypertensive medication intake previously to SAH prescribed by a physician, hypertension preceding SAH confirmed by a physician; if criteria 1 and 2 were ...