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Study-defined hypertension is not a statistically significant predictor of recurrence in intracranial aneurysmsHigh blood pressure may not predict aneurysm recurrence after treatment

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Key Takeaway
Note that study-defined hypertension is not a statistically significant predictor of recurrence in intracranial aneurysms.

This systematic review and meta-analysis evaluated 2,442 observations from 8 studies to determine if study-defined hypertension status influenced recurrence-related outcomes, including recurrence, recanalization, and reperfusion, in adult patients with intracranial aneurysms undergoing endovascular treatment. The analysis found a statistically non-significant association between study-defined hypertension and these outcomes (OR 1.36; 95% CI 0.92-2.00; p = 0.104).

Several limitations were noted, including the lack of recurrence data categorized by achieved SBP/DBP targets and the inability to quantitatively pool blood pressure variability studies due to heterogeneous clinical outcomes. The evidence for recurrence is based on history-based hypertension, while evidence for achieved blood pressure and variability is considered indirect.

Clinical evidence is currently insufficient to establish study-defined hypertension as an independent predictor of recurrence or to recommend specific blood pressure targets for recurrence prevention. Practitioners should note the lack of statistical significance in the association between hypertension and recurrence outcomes in this meta-analysis.

How this fits prior evidence

This finding addresses a gap in the clinical management of intracranial aneurysms by evaluating the impact of hypertension on recurrence. While prior evidence notes the role of hypertension-mediated cerebrovascular injury in cognitive decline, this meta-analysis specifically examines whether study-defined hypertension serves as a predictor for recurrence following endovascular treatment. The results do not establish a statistically significant link between hypertension and recurrence-related outcomes.

Living with an intracranial aneurysm is a heavy burden, and many patients worry about whether their blood pressure will cause the aneurysm to return after treatment. Doctors often look at blood pressure as a key factor in determining how well a procedure works and how safe a patient remains.

Researchers looked at 2,442 observations from 8 different studies involving adults who underwent endovascular treatment for these aneurysms. They compared patients with a history of high blood pressure to those without it. The goal was to see if having high blood pressure made it more likely that the aneurysm would reappear, a process called recurrence.

While the numbers showed slightly more events in the high blood pressure group, the difference was not statistically significant. This means the data is currently not strong enough to say that high blood pressure is a reliable predictor of recurrence. Because the evidence is still limited, doctors cannot yet recommend a specific blood pressure target for preventing these issues.

What this means for you:
Current evidence does not show that a history of high blood pressure predicts if an aneurysm will return.

Common questions

Does having high blood pressure mean my aneurysm is more likely to return?

The study looked at 2,442 observations and found that a history of high blood pressure did not have a statistically significant link to aneurysm recurrence. While there were 242 events in the high blood pressure group and 317 in the non-hypertension group, the difference was not strong enough to prove that high blood pressure is an independent predictor of recurrence.

Can doctors use blood pressure to predict if my treatment will work?

Currently, the evidence is not enough to say that a history of high blood pressure can predict if an aneurysm will return. Because the results were not statistically significant, doctors cannot yet use this specific data to recommend a specific blood pressure target to prevent recurrence after your procedure.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
BackgroundRecurrence, recanalization, reperfusion, or retreatment remains an important durability limitation after endovascular treatment of intracranial aneurysms. Most recurrence studies characterize blood pressure exposure as a history or study-defined diagnosis of hypertension rather than achieved post-treatment systolic or diastolic blood pressure.ObjectiveTo quantify the association between study-defined/history-based hypertension status and recurrence-related outcomes after endovascular aneurysm treatment, and to separately summarize indirect clinical evidence on achieved blood pressure, blood pressure variability, and mechanistic hemodynamic evidence.MethodsPubMed/MEDLINE, Ovid MEDLINE, and Embase were searched from database inception through April 2026. The direct recurrence synthesis included adult endovascular aneurysm cohorts reporting recurrence-related outcomes according to hypertension status. Indirect clinical studies of achieved blood pressure or blood pressure variability and mechanistic computational-fluid-dynamics studies were synthesized separately. Odds ratios (ORs) for the direct recurrence analysis were pooled using inverse-variance random-effects models with restricted maximum-likelihood estimation and Hartung-Knapp adjustment. Study selection was independently performed by two reviewers at title/abstract and full-text stages; unresolved disagreements were adjudicated by a third reviewer.ResultsThirty-one studies were included. Eight studies provided extractable 2 × 2 data for the primary recurrence-related analysis (2,442 observations: 1,231 in the hypertension/high-BP-status group and 1,211 in the non-hypertension group; 559 recurrence-related events overall, 242 and 317 respectively). Study-defined hypertension showed a directionally higher but statistically non-significant association with recurrence/recanalization/reperfusion (OR 1.36, 95% CI 0.92–2.00; p = 0.104; I2 = 31.4%). No eligible recurrence study reported recurrence according to achieved SBP/DBP target categories. The overlapping full and matched Lee 2021 controlled-versus-uncontrolled hypertension estimates were presented separately and were not pooled. BP-variability studies addressed heterogeneous clinical outcomes and were not quantitatively pooled.ConclusionCurrent evidence is insufficient to establish study-defined hypertension as an independent predictor of recurrence after endovascular aneurysm treatment or to recommend a recurrence-preventive blood pressure target. The available direct evidence concerns predominantly history-based hypertension status, whereas achieved blood pressure and blood pressure variability evidence is indirect for angiographic recurrence.
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