Beta-blocker combined with alpha-2 agonist in patients with severe aneurysmal subarachnoid hemorrhage: A single-center retrospective observational study

Background and aim

Excessive sympathetic nerve system (SNS) activation played a key role in the pathophysiology of acute brain injury, which was also named stress response. Aneurysmal subarachnoid hemorrhage (aSAH), as one type of acute brain injury, was a worldwide primary life-threatening disease. It’s reported that beta-blocker or alpha-2 agonist could alleviate the stress response in acute injury, respectively. The present study aimed to investigate the safety and effectivity of the stress-reducing therapy in patients with severe aSAH using the bundle of beta-blocker combined with alpha-2 agonist.

Methods

The retrospective, observational study consecutively collected ninety-nine patients with severe aSAH in our center (single center) from December 2019 to September 2023. These patients were divided into the stress-reducing therapy (SRT) group and no stress-reducing therapy (nSRT) group according to whether they obtained stress-reducing therapy. Accordingly, there are sixty-three patients in SRT group and thirty-six in nSRT group. Variables related to population, consciousness, heart rate, respiratory rate, systolic pressure, diastolic pressure, sodium ion (Na+), aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatine (Cr), glomerular filtration rate (GFR), temperature, blood sugar, white blood cell (WBC), albumin (ALB), prealbumin (p-ALB), and hospital costs, length of stay in the hospital, length of stay in neurosurgical intensive care unit (NICU), and Glasgow outcome scale (GOS) were recorded and analyzed on the third, seventh and tenth day in all patients, respectively.

Results

Catecholamine significantly increased in all patients in the stress-reducing therapy (SRT) group and no stress-reducing therapy (nSRT) groups at admission. The consciousness (P = 0.007), heart rate (P = 0.004), respiratory rate (P = 0.001), Cr (P = 0.011), temperature (P = 0.000) and blood sugar (P = 0.003) were statistically different between groups on the third day of admission. The consciousness (P = 0.003), Na+ (P = 0.000) were statistically different between groups on the seventh day of admission. The onsciousness (P = 0.009), respiratory rate (P = 0.031), systolic pressure (P = 0.000), diastolic pressure (P = 0.020), Cr (P = 0.002), temperature (P = 0.000), GFR (P = 0.012) and ALB (P = 0.003) were statistically different between groups on the tenth day of admission. Compared with the nSRT group, patients in the SRT group had abetter outcome at discharge (GOS, P = 0.012).

Conclusion

In the present study, catecholamine of the patients with severe aSAH was significantly increased at admission, showing that excessive SNS activation occurred in patients with onset of severe aSAH ictus. The combination of beta-blockers and alpha-2 agonists can safely and effectively mitigate the stress response caused by excessive activation of the sympathetic nervous system in severe aSAH patients, reducing the mortality rate, severe disability rate, length of hospital stay, and overall hospitalization costs of patients with aneurysmal subarachnoid hemorrhage.