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Objectives <p>Aneurysm wall enhancement (AWE) on 3T magnetic resonance aneurysm wall imaging (MR-AWI) predicts aneurysm growth and rupture during follow-up. However, its association with hypertension and the impact of blood pressure (BP) control remain unclear. This study aims to evaluate the association between hypertension, BP control, and AWE in patients with unruptured intracranial aneurysms (UIAs).</p> Materials and methods <p>We retrospectively analyzed patients with UIAs from three prospective cohorts (IARP-CP, 100-Project, 100-Project II) who had 3.0 T MR-AWI. AWE was categorized into three patterns: no enhancement, focal enhancement, and circumferential enhancement. Hypertension was defined as a history of hypertension and/or use of antihypertensive drugs. Hypertensive patients were categorized as well-controlled (systolic BP [SBP] &lt; 140 mmHg and diastolic BP [DBP] &lt; 90 mmHg) or poorly controlled (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg). Propensity score matching (PSM) (1:1) balanced confounders (age, sex, BMI, comorbidities, aneurysm characteristics). Ordinal logistic regression assessed associations between hypertension, BP control, and AWE.</p> Results <p>From a cohort of 1351 patients with 1416 UIAs who had MR-AWI, we matched 427 hypertensive patients with 427 normotensive patients. Hypertension was associated with higher AWE prevalence in both the total cohort (odds ratio (OR) 1.98, 95% CI: 1.57–2.51) and the matched cohort (OR 1.93, 95% CI: 1.49–2.49). Compared with normotensive patients, well-controlled hypertension (OR 1.72, 95% CI: 1.31–2.28) and poorly controlled hypertension (OR 2.58, 95% CI: 1.77–3.77) were linked to higher AWE prevalence.</p> Conclusion <p>Hypertension, particularly poorly controlled hypertension, is associated with higher AWE prevalence in patients with UIAs, suggesting a potential link between BP status and aneurysm wall imaging characteristics, which warrants further longitudinal follow-up studies to clarify its clinical significance.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis><i> Hypertension is a well-established risk factor for aneurysm rupture, but its association with aneurysm wall enhancement (AWE) and role of blood pressure control remain unknown</i>.</p> <p><Emphasis Type="BoldItalic">Findings</Emphasis><i> This study found that hypertension, especially poorly controlled hypertension, is significantly associated with a higher prevalence of AWE in patients with unruptured intracranial aneurysms (UIAs)</i>.</p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis><i> This study underscores the importance of strict blood pressure control in UIA management, as it may mitigate vessel wall inflammation and subsequent risk of aneurysm progression and rupture</i>.</p> Graphical Abstract <p></p>

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Association of hypertension and blood pressure control with aneurysm wall enhancement in unruptured intracranial aneurysms: a multicenter propensity score-matched study

  • 期刊论文

  • 发表日期：

    2026年7月4日

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  • Pengjun Jiang,
  • Xin Nie,
  • Mervyn D. I. Vergouwen,
  • Jun Wu,
  • Yi Yang,
  • Zheng Wen,
  • Yang Liu,
  • Mahmud Mossa-Basha,
  • Michael R. Levitt,
  • Bing Zhao,
  • Jinrui Ren,
  • Xiaolin Chen,
  • Yisen Zhang,
  • Hongye Zeng,
  • Beibei Sun,
  • Xinyi Dong,
  • Xiaomeng Lyu,
  • Rong Wang,
  • Shuo Wang,
  • Qingyuan Liu,
  • Chengcheng Zhu

摘要

Objectives

Aneurysm wall enhancement (AWE) on 3T magnetic resonance aneurysm wall imaging (MR-AWI) predicts aneurysm growth and rupture during follow-up. However, its association with hypertension and the impact of blood pressure (BP) control remain unclear. This study aims to evaluate the association between hypertension, BP control, and AWE in patients with unruptured intracranial aneurysms (UIAs).

Materials and methods

We retrospectively analyzed patients with UIAs from three prospective cohorts (IARP-CP, 100-Project, 100-Project II) who had 3.0 T MR-AWI. AWE was categorized into three patterns: no enhancement, focal enhancement, and circumferential enhancement. Hypertension was defined as a history of hypertension and/or use of antihypertensive drugs. Hypertensive patients were categorized as well-controlled (systolic BP [SBP] < 140 mmHg and diastolic BP [DBP] < 90 mmHg) or poorly controlled (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg). Propensity score matching (PSM) (1:1) balanced confounders (age, sex, BMI, comorbidities, aneurysm characteristics). Ordinal logistic regression assessed associations between hypertension, BP control, and AWE.

Results

From a cohort of 1351 patients with 1416 UIAs who had MR-AWI, we matched 427 hypertensive patients with 427 normotensive patients. Hypertension was associated with higher AWE prevalence in both the total cohort (odds ratio (OR) 1.98, 95% CI: 1.57–2.51) and the matched cohort (OR 1.93, 95% CI: 1.49–2.49). Compared with normotensive patients, well-controlled hypertension (OR 1.72, 95% CI: 1.31–2.28) and poorly controlled hypertension (OR 2.58, 95% CI: 1.77–3.77) were linked to higher AWE prevalence.

Conclusion

Hypertension, particularly poorly controlled hypertension, is associated with higher AWE prevalence in patients with UIAs, suggesting a potential link between BP status and aneurysm wall imaging characteristics, which warrants further longitudinal follow-up studies to clarify its clinical significance.

Key Points

Question Hypertension is a well-established risk factor for aneurysm rupture, but its association with aneurysm wall enhancement (AWE) and role of blood pressure control remain unknown.

Findings This study found that hypertension, especially poorly controlled hypertension, is significantly associated with a higher prevalence of AWE in patients with unruptured intracranial aneurysms (UIAs).

Clinical relevance This study underscores the importance of strict blood pressure control in UIA management, as it may mitigate vessel wall inflammation and subsequent risk of aneurysm progression and rupture.

Graphical Abstract