Gc. Dennis et al., SUBARACHNOID HEMORRHAGE IN THE AFRICAN-AMERICAN POPULATION - A COOPERATIVE STUDY, Journal of the National Medical Association, 89(2), 1997, pp. 101-108
The clinical outcome of patients Following subarachnoid hemorrhage is
complicated by delayed cerebral ischemia and contributing factors such
as hypertension. To observe the impact of hypertension and delayed ce
rebral ischemia on the outcome of a predominantly African-American coh
ort following subarachnoid hemorrhage, both retrospective (n=42) and p
rospective (n=21) studies were conducted. In the total pool (n=63), th
e mean age was 49.7 years (range: 17 to 80) with a preponderance of fe
male patients (70%). Aneurysm formation was significant in the region
of the posterior communicating artery. Of the patients reviewed, 73.8%
had preexisting hypertension and 45.9% developed delayed cerebral isc
hemia. Approximately 89% of the patients who suffered from delayed cer
ebral ischemia had hypertension. Results failed to display any signifi
cant beneficial association between the use of the calcium channel blo
cker nimodipine and delayed cerebral ischemia. Use of the antifibrinol
ytic drug aminocaproic acid demonstrated a worse patient outcome. It i
s not recommended that aminocaproic acid be used in this population. S
ubsequently, due to the proportional occurrence of delayed cerebral is
chemia in hypertensive patients following subarachnoid hemorrhage, it
is suggested that prophylactic surgical management of unruptured intra
cranial aneurysms be considered in hypertensive patients. Further stud
y is needed to discern the association between hypertension, delayed c
erebral ischemia, and stroke in patients following subarachnoid hemorr
hage.