Beta-Blockers for Subarachnoid Hemorrhage: When Should We Use Them?

In the systematic review and meta-analysis conducted by Ramesh el al., they reached the conclusion that in adult patients with aneurysmal subarachnoid hemorrhage (aSAH), beta-blocker therapy is associated with lower all-cause mortality at the longest specified time point. In this meta-analysis, hypotension was not informed as an adverse event in any study, and most of the studies included in the analysis did not inform of adverse events at all [1], which must not be interpreted as safety of the intervention, especially considering that hemodynamic management is the cornerstone of the treatment for acute cerebral injury, in which loss of autoregulation puts the cerebral parenchyma at risk when extreme values of arterial pressure occur. Because of the complexity of clinical manifestations of aSAH and the involvement of the brain–heart-lung axis, the use of advanced monitoring devices such as pulse contour cardiac output (PiCCO), pulse densitometry and pulmonary artery catheterization have been proposed by some authors [4]. The results of the systematic review and meta-analysis suggest that patients with aSAH can benefit from advanced hemodynamic monitoring.