Guidelines in Action: Volume and Blood Pressure Management After Aneurysmal Subarachnoid Hemorrhage

The American Heart Association/American Stroke Association (AHA/ASA) published an updated set of guidelines in 2023 for the management of aneurysmal subarachnoid hemorrhage (aSAH). This clinical case review demonstrates the implementation of these guidelines regarding volume and blood pressure management in patients with aSAH. This review discusses the treatment of a patient who presents with an aSAH and subsequently develops symptomatic vasospasm. In accordance with the 2023 AHA/ASA aSAH guidelines, treatment follows the following principles: (1) avoid prophylactic hemodynamic augmentation; (2) maintain euvolemia; and (3) consider inducing hypertension in patients with symptomatic vasospasm, while also assessing risks associated with hypertension induction. The clinical evidence supporting these principles is reviewed. This clinical case review serves to demonstrate how the 2023 AHA/ASA aSAH guidelines can be implemented into clinical practice, regarding volume and blood pressure management in patients with aSAH. © 2023 American Heart Association, Inc.