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  • Original Article
  • OPEN ACCESS

Evidence Summary for Blood Pressure Management in Patients with Ruptured Intracranial Aneurysms: Implications for Clinical Nursing Practice

  • Huan Wang1,#,
  • Juanfang Zhang1,#,
  • Xuan Tan2,* ,
  • Li Sun2,* ,
  • Lianlian Qu2,
  • Yuxin Zhan1,
  • Sisi Zhang1,
  • Danfeng Li1,
  • Qiong He1,
  • Xiaomei Wei1 and
  • Hailan Peng1
 Author information 

Abstract

Background and objectives

Given that hemodynamic fluctuations acutely escalate the risk of devastating rebleeding and secondary neurological deficits in unsecured ruptured intracranial aneurysms, this study aimed to synthesize the best available evidence for blood pressure management in this population and to provide an evidence-based foundation for clinical nursing practice.

Methods

A systematic search was conducted in domestic and international databases and relevant websites for evidence pertaining to blood pressure management in patients with ruptured intracranial aneurysms, including clinical practices, guidelines, expert consensuses, evidence summaries, and systematic reviews/meta-analyses. The search period covered database inception up to June 2025. Two researchers independently performed literature quality assessments and evidence extraction, with particular attention to nursing-relevant evidence on hemodynamic monitoring, bedside assessment, complication prevention, fluid management, and follow-up coordination.

Results

A total of 17 studies were included, comprising 11 guidelines, 4 expert consensuses, and 2 clinical decision entries. The synthesized evidence yielded 32 recommendations, structured into 6 core clinical domains: personnel and environmental configuration, individualized blood pressure targeting, precision hemodynamic monitoring, complication prevention, fluid therapy strategy, and longitudinal follow-up protocols. These recommendations further clarified key nursing responsibilities in triage coordination, continuous blood pressure surveillance, neurological assessment, delayed cerebral ischemia surveillance, fluid balance monitoring, and long-term follow-up.

Conclusion

Blood pressure management in patients with ruptured intracranial aneurysms should be individualized and multidisciplinary. The synthesized evidence highlights key nursing priorities in hemodynamic monitoring, delayed cerebral ischemia surveillance, fluid management, and follow-up coordination, and may inform standardized clinical nursing protocols.

Keywords

Intracranial aneurysm, Aneurysmal subarachnoid hemorrhage, Blood pressure management, Evidence-based nursing, Evidence summary, Neurocritical care

Introduction

Intracranial aneurysms (IAs) arise from localized pathological dilations of the cerebral arterial wall, attributed to congenital defects in the tunica media or acquired elastic lamina degeneration under the influence of hemodynamic factors.1 Aneurysmal subarachnoid hemorrhage (aSAH), resulting from IA rupture, accounts for approximately 85% of all subarachnoid hemorrhage cases.2

Clinically, aSAH is characterized by high rates of mortality and morbidity; prior investigations have documented cumulative mortality rates reaching 37%, 60%, and 75% at 24 h, 48 h, and 7 days post-rupture, respectively.3 Among long-term survivors, approximately 60% fail to return to their premorbid level of functioning,4 and 40–70% experience cognitive impairment.5

Moreover, aSAH imposes a substantial healthcare and economic burden, with its initial hospitalization costs and resource utilization ranking highest among all neurovascular stroke subtypes.6 Hypertension represents a critical risk factor for the occurrence and rebleeding of aSAH, with approximately 50% of patients with aSAH having comorbid hypertension. Conversely, hypotension may precipitate cerebral hypoperfusion and increase the risk of cerebral infarction.7 Therefore, effective and evidence-based blood pressure management is of paramount importance in reducing the risk of rebleeding and improving patient outcomes. Nevertheless, clinical consensus remains fragmented regarding optimal blood pressure targets, monitoring frequencies, and pharmacological titration during the hyperacute and perioperative phases of ruptured IAs, leading to considerable variability in bedside practice. Consequently, this study aimed to systematically retrieve, critically appraise, and synthesize the latest evidence on blood pressure management in patients with ruptured IAs, providing a standardized, evidence-based matrix to inform clinical nursing practice.

Materials and methods

This evidence summary was systematically conducted following the Joanna Briggs Institute (JBI) methodology for evidence synthesis. The reporting process was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement, where applicable, to ensure methodological transparency and reproducibility.

Formulation of the evidence-based question

The evidence-based question was structured using the PIPOST framework developed by the JBI Evidence-Based Healthcare Center.8 The components were defined as follows: population (P): adult patients with ruptured IA; intervention (I): blood pressure management measures, including but not limited to blood pressure targets, monitoring frequency and modalities, selection and administration of antihypertensive agents, nonpharmacological interventions, and multidisciplinary management protocols; professional (P): neurosurgeons, physicians, and nurses in neurosurgery and neuro-intensive care units; outcome (O): rebleeding rate, incidence of cerebral vasospasm, incidence of delayed cerebral ischemia, among others; setting (S): neurosurgery wards, neurosurgical intensive care units, and stroke units in tertiary hospitals with the capacity to manage aneurysmal disease; type of evidence (T): clinical practices, guidelines, expert consensuses, evidence summaries, and systematic reviews/meta-analyses.

Literature search strategy

A systematic search was conducted following the “5S” pyramid model. The following databases and websites were searched: UpToDate, BMJ Best Practice, JBI, The Cochrane Library, PubMed, CINAHL, Embase, the Scottish Intercollegiate Guidelines Network (SIGN), the National Institute for Health and Care Excellence (NICE), the National Guideline Clearinghouse (NGC), the Canadian Medical Association Clinical Practice Guidelines Infobase (CMA Infobase), the Registered Nurses’ Association of Ontario (RNAO), the Guidelines International Network (GIN), the American Heart Association (AHA), the European Stroke Organisation (ESO), the Stroke Alliance for Europe (SAFE), the European Academy of Neurology, China National Knowledge Infrastructure (CNKI), WanFang Data, VIP Database, SinoMed, and the Chinese Medical Journal Database. A combination of MeSH terms and free-text terms was employed. Chinese search terms included “intracranial aneurysm,” “cerebral aneurysm,” “subarachnoid hemorrhage,” “blood pressure management,” and “evidence summary.” English search keywords were systematically aligned with the primary database formulations, including “Intracranial Aneurysm,” “Subarachnoid Hemorrhage,” “Blood Pressure Management,” “best practice,” “evidence summary,” “systematic review,” “meta-analysis,” and “Practice Guideline.” The search period spanned from database inception to June 2025. The precise Boolean formulas for individual databases, the explicit search execution timeline, and the rigorous procedural details of the quality appraisal process are detailed and compiled in Supplementary File 1.

Inclusion and exclusion criteria

Inclusion criteria

(1) study population: patients with ruptured IA (aged ≥18 years); (2) study content: blood pressure management strategies; when direct evidence focused on ruptured IAs was unavailable, high-quality publications on adjacent neurocritical care conditions, including spontaneous intracerebral hemorrhage and acute ischemic stroke, were accepted as indirect evidence; and (3) study type: clinical practices, guidelines, expert consensuses, evidence summaries, and systematic reviews/meta-analyses.

Exclusion criteria

(1) articles for which full text was unavailable or data were incomplete; (2) articles that failed quality appraisal; (3) guidelines or systematic reviews that had been superseded by comprehensive updated official editions; and (4) duplicate publications or directly translated guidelines. Guidelines without comprehensive updated replacement versions were not subject to criterion (3).

Literature screening and data extraction

Two researchers trained in evidence-based methodology independently performed literature screening and data extraction. Initially, titles and abstracts were reviewed for preliminary screening, and studies that clearly did not meet the inclusion criteria were excluded. The full texts of the remaining articles were then reviewed for secondary screening to finalize the included literature. Any disagreements during the screening process were resolved through discussion between the two researchers or by consultation with a third researcher until consensus was reached. Due to the scarcity of nursing-specific protocols addressing pure ruptured IA hemorrhage cohorts, relevant guidelines from broader stroke and intracerebral hemorrhage categories were cross-referenced to fill clinical practice gaps. To preserve disease specificity, these indirect items were rigorously evaluated by our multidisciplinary expert panel and have been explicitly stratified as “Indirect” in Table 1.9–25

Table 1

Summary of evidence on blood pressure management in patients with ruptured intracranial aneurysms

TopicEvidence contentLevel of evidenceRecommended levelEvidence typeClinical scenarioInapplicable situations/Special precautions
Personnel and environmental configuration
Multidisciplinary collaboration1. For patients with aSAH, care should be provided in a dedicated neurocritical care unit by a multidisciplinary team131ADirectSuspected aSAH triage (<6 h from onset)-
Stroke unit establishment2. Acute stroke unit care reduces both death and dependency for patients with ICH in comparison with care on a general ward231AIndirectConfirmed aSAH critical monitoring (days 3-14)-
3. Patients with intracerebral hemorrhage should be directly transferred to a hyperacute specialized stroke unit for consciousness tracking; any acute neurological deterioration dictates urgent re-imaging21,235BIndirectHunt-Hess II-IV patients requiring serial GCS trackingImpending brainstem herniation requiring immediate surgery
BP control targets
Principles of BP control4. Maintain systolic blood pressure (SBP) strictly between 120–160 mmHg and ensure mean arterial pressure (MAP) stays above 90 mmHg in aSAH cohorts to mitigate re-rupture secondary to hypoperfusion10,16,19–21,255ADirectBefore aneurysm securing interval of ruptured unsecured aneurysmPatients with severe intracranial hypertension (ICP >25 mmHg) or compromised CPP require individualized blood pressure targets to avoid CPP reduction resulting from excessive blood pressure lowering
5. Following surgical securing of the aneurysm, sustain MAP within 80–100 mmHg provided the patient presents no signs of intracranial hypertension or cerebral vasospasm171ADirectAfter aneurysm securing phase (clipped/coiled) without vasospasmIn patients with symptomatic cerebral vasospasm or DCI, induced hypertension may be required; therefore, these blood pressure targets should not be applied rigidly
History of hypertension6. For patients presenting with a history of chronic hypertension or presenting clear radiological features of intracranial hypertension, titrate SBP and MAP toward their upper safety boundaries (160 mmHg and 100 mmHg, respectively)163BDirectaSAH with chronic poorly controlled hypertension baselineMicro-aneurysm morphology showing active acute rebleeding signs
No history of hypertension7. For individuals lacking a hypertensive history or signs of elevated intracranial pressure, target the lower operational boundaries (SBP near 120 mmHg; MAP near 80 mmHg)165BDirectYoung, previously normotensive patients (Hunt-Hess I-II)New focal deficits indicating active cerebral hypoperfusion.
BP monitoring
Monitoring method8. Utilize invasive continuous intra-arterial tracking or standardized non-invasive modalities for precise post-operative SBP surveillance10,112ADirectBeat-to-beat tracking during rapid continuous IV titrationSevere peripheral arterial disease preventing arterial cannulation
Monitoring frequency9. Record blood pressure immediately upon emergency presentation, maintaining a 15-min tracking frequency until therapeutic targets achieve documented stability within the initial 24 h185AIndirectFirst 24 h of admission or active infusion adjustmentsStable maintenance phases (>48 h post-op) on fixed doses
Management principles10. For cases presenting acute intraparenchymal bleeding, initiate antihypertensive titration within 2 h of symptom onset; ensure the overall SBP reduction does not drop beyond 90 mmHg from baseline parameters12,191AIndirectStress-induced SBP spikes (>180 mmHg) post-rupturePrecipitous, abrupt iatrogenic SBP reductions inducing infarction
11. Implement systematic and gradual reduction of elevated SBP thresholds in patients presenting with un-occluded or unsecured aneurysms9,121ADirectControlled, step-wise SBP down-titration pre-operativelyInduced profound iatrogenic systemic hypotension (SBP <100 mmHg)
12. Enforce strict vigilance to prevent post-operative systemic hypotension following the repair of ruptured intracranial aneurysms10,111ADirectPost-operative daily maintenance during vasospasm window-
13. Prioritize short-acting, highly titratable intravenous agents (e.g., nicardipine or labetalol) when active BP lowering is required; routinely avoid potent cerebral vasodilators such as nitroprusside or nitroglycerin to prevent hemodynamic volatility9,12,18,201ADirectAcute neurocritical settings requiring second-by-second SBP controlRoutine use of vasodilators that may increase intracranial pressure, such as sodium nitroprusside, is not recommended. In selected circumstances, potential benefits should be carefully weighed against risks with close monitoring
14. In patients with acute aSAH and unsecured aneurysms, frequent blood pressure monitoring and tailored BP control leveraging short-acting medications are highly recommended to strictly avoid severe hypotension, extreme hypertension, and pathological BP variability prior to definitive vascular securing135ADirectHyperacute before aneurysm securing window (<24 h from symptom onset)Intermittent manual IV boluses without continuous physiological tracking
15. In patients with acute intracerebral hemorrhage displaying severe hypertensive spikes (SBP >200 mmHg or MAP >150 mmHg), contemplate rapid, intensive blood pressure reduction supported by 5-min tracking intervals242BIndirectMalignant hypertensive crisis (SBP >200 mmHg)
before aneurysm securing		Terminal structural failure (bilateral fixed mydriasis)
16. For intraparenchymal bleeding cases with SBP >180 mmHg or MAP >130 mmHg accompanied by clear signs of intracranial hypertension, continuously track ICP and adjust intravenous titrations to safeguard a cerebral perfusion pressure (CPP) window of 61–80 mmHg241AIndirectComatose high-grade aSAH with functional invasive ICP monitorsAggressive empirical BP lowerings without real-time CPP tracking
17. For intraparenchymal bleeding cases with SBP >180 mmHg or MAP >130 mmHg but without elevated ICP clinical indicators, lower the blood pressure moderately and mandate formal clinical re-evaluations every 15 min243BIndirectAlert patients with stable baseline intracranial complianceSudden explosive headache or projectile vomiting (suspected micro-rupture)
18. If patients requiring continuous blood pressure maintenance possess intact, functional swallowing mechanisms, safely resume their established pre-admission oral antihypertensive regimens191AIndirectPost-op plateau phase where patient tolerates oral intakePersistent depressed consciousness levels or severe neuro-agitation
19. In the presence of acute dysphagia or altered consciousness levels, temporarily withhold prior oral medications and substitute with intravenous titrations until swallowing function stabilizes or a nasogastric pathway is secured191AIndirectPatients with lower cranial nerve palsies or bulbar paralysisOral administration without screening (absolute fatal aspiration risk)
Non-pharmacological interventions20. Minimize external environmental triggers and defer non-urgent invasive bedside nursing tasks to safeguard patient calmness and prevent paroxysmal rebleeding episodes101ADirectStandard non-pharmacological neuro-protection routine in single rooms-
21. Enforce strict bed rest regimes, execute systematic bowel regularity protocols to avoid straining, and maintain accurate hourly monitoring of systemic fluid inputs and outputs9,10,12,201ADirectPre-operative immobilization to minimize transmural pressure spikesBowel management interventions that may provoke a Valsalva maneuver or cause significant blood pressure fluctuations should be avoided
22. Manage severe headache presentations or psychomotor agitation with minimal effective dosing of analgesics and sedatives; implement early weaning protocols as clinical tolerance permits9,111ADirectThunderclap headache/agitation driving sympathetic hypertensive loopsExcessive sedation that interferes with neurological assessment should be avoided; daily sedation interruption or awakening trials should be considered when clinically appropriate
Complication prevention
DCI23. Utilize specialized neurovascular imaging techniques (e.g., CTA or CTP) to detect subclinical vasospasm and predict the onset of delayed cerebral ischemia (DCI) when physical examinations are restricted10,13,201ADirectHigh-grade, sedated aSAH where serial clinical exam is impossibleFully alert, neurologically stable low-grade patients
24. For high-grade aSAH cohorts, consider advanced invasive neuromonitoring parameters, including brain tissue oxygen tension and localized microdialysis (lactate/pyruvate and glutamate ratios), to predict DCI trends132BDirectSevere, high-grade thick clot patients (modified Fisher 4) post-opCommunity centers lacking multimodality sensor calibration tools
25. Standardize the application of validated neurological tracking tools (such as GCS and NIHSS scores) to perform serial assessments for DCI and secondary neurovascular declines10,21,251ADirectShift-to-shift handovers and quantitative serial tracking for DCI-
Cerebral vasospasm26. Maintain normovolemia to prevent DCI; routine prophylactic hypervolemia is not recommended142ADirectAsymptomatic postoperative phase within the DCI risk windowPatients with symptomatic cerebral vasospasm require individualized volume and blood pressure management based on cerebral perfusion status
27. Schedule transcranial Doppler (TCD) scans daily or every other day to perform regular screening for vasospasm trajectories in aSAH patients141ADirectBedside non-invasive velocity screening during peak vasospasm window-
28. Administer standard oral nimodipine regimens for vasospasm prophylaxis; implement continuous intravenous nimodipine infusions as an authorized alternative only if oral/enteral ingestion pathways are compromised10–12,14,15,20–23,251ADirectRoutine pharmacological neuro-protection for all confirmed aSAH casesIn patients with refractory systemic hypotension (SBP <90 mmHg), nimodipine dose adjustment, temporary discontinuation, or alternative treatment strategies should be considered
29. Dual antiplatelet therapeutic approaches may be considered to lower the overall incidence of clinical vasospasm and secondary DCI events10,191BDirectSubpopulation undergoing endovascular coiling with stent placementEarly phases of open clipping, unsecured aneurysms, or coagulopathy
Volume management
30. Avoid the routine preoperative implementation of hypervolemia, hemodilution, and hypertensive therapy (traditional 3H protocols); restrict these interventions strictly to SAH individuals with documented hypovolemic states19,211ADirectFluid profiling of neurologically intact, normovolemic perioperative patientsProphylactic traditional 3H therapy in asymptomatic cohort
31. Determine fluid status by combining clinical volume assessments with hemodynamic monitoring parameters142ADirectDynamic fluid balance titration during intensive neurocritical monitoringEmpirical fluid bolus ordering without baseline hemodynamic checks
Follow-up
32. Arrange the initial post-operative neuroimaging follow-up window at 3–6 months, followed by serial surveillance at years 1, 2, 3, and 5, transitioning subsequently to a 3-to-5-year maintenance interval191ADirectOutpatient surveillance tracking coil compaction or recurrence-

“Direct” indicates primary evidence derived explicitly from ruptured intracranial aneurysm literature, representing the baseline mandate for nursing interventions. “Indirect” signifies supplementary evidence adapted from authoritative spontaneous intracerebral hemorrhage or general stroke guidelines to fill clinical practice gaps where pure ruptured intracranial aneurysm hemorrhage nursing evidence is currently limited. In the synthesis weighting scheme, all indirect items were systematically assigned a conditional/supplementary weight rather than disease-specific authority and were rigorously validated for pathophysiological safety by our expert panel before clinical adoption. 3H, hypervolemia, hemodilution, and hypertensive therapy; aSAH, aneurysmal subarachnoid hemorrhage; BP, blood pressure; CPP, cerebral perfusion pressure; CTA, computed tomography angiography; CTP, computed tomography perfusion; DCI, delayed cerebral ischemia; GCS, Glasgow Coma Scale; ICH, intracerebral hemorrhage; ICP, intracranial pressure; IV, intravenous; MAP, mean arterial pressure; NIHSS, National Institutes of Health Stroke Scale; SAH, subarachnoid hemorrhage; SBP, systolic blood pressure; TCD, transcranial Doppler.

Quality appraisal of included literature

Two researchers independently appraised the quality of the included literature using appropriate standardized tools. In cases of disagreement, a third trained researcher was consulted to reach consensus. Guidelines were appraised using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument,26 which evaluates six domains across 23 items; the intraclass correlation coefficient (ICC) was calculated to assess consistency between reviewers. Expert consensuses were appraised using the JBI Critical Appraisal Tool for Expert Opinion.27 Independent quality appraisal using traditional instruments was not conducted for the UpToDate clinical decision entries, as static frameworks are structurally incompatible with continuously updated databases. To control bias and ensure evidence validity, our research team performed secondary validation by independently retrieving and verifying the original primary studies and foundational guidelines referenced within the UpToDate transcripts prior to evidence synthesis.

Evidence extraction and summary

Two trained researchers independently extracted and cross-checked the evidence, with discrepancies resolved by a third researcher. Evidence integration followed three criteria: (1) consistent recommendations were consolidated into the clearest statement; (2) complementary data were logically merged; and (3) conflicting evidence was resolved by hierarchically prioritizing evidence-based sources, high-quality methodologies, and contemporary authoritative publications, while prioritizing direct ruptured aneurysm data over extrapolated indirect contexts. The extracted evidence was graded using the JBI Evidence Pre-Grading System (2014 version),28 where Levels 1 through 5 represent decreasing methodological rigor and evidence strength.

Results

Literature search

A total of 2,594 articles were retrieved. Following deduplication, title and abstract screening, and full-text review, 17 articles were ultimately included.9–25 These comprised 11 guidelines,10,11,13,15,18–23,25 4 expert consensuses,12,14,16,17 and 2 clinical decision entries.9,24 The literature screening process is illustrated in Figure 1, and the basic characteristics of the included studies are presented in Table 2.9–25

Flowchart of literature screening.
Fig. 1  Flowchart of literature screening.

AHA, American Heart Association; CINAHL, Cumulative Index to Nursing and Allied Health Literature; CMA Infobase, Canadian Medical Association Clinical Practice Guidelines Infobase; CNKI, China National Knowledge Infrastructure; ESO, European Stroke Organisation; GIN, Guidelines International Network; JBI, Joanna Briggs Institute; NGC, National Guideline Clearinghouse; NICE, National Institute for Health and Care Excellence; RNAO, Registered Nurses’ Association of Ontario; SAFE, Stroke Alliance for Europe; SIGN, Scottish Intercollegiate Guidelines Network; SinoMed, Chinese Biomedical Literature Service System; VIP, Chinese VIP Journal Database.

Table 2

Basic characteristics of included literature (n = 17)

AuthorSourceType of literatureTitleYear of publication
Singer et al.9UpToDateClinical DecisionAneurysmal subarachnoid hemorrhage: Treatment and prognosis2025
Society of Neurosurgery of Chinese Medical Association10CNKIGuidelineChinese Guideline for the Clinical Management of Patients with Ruptured Intracranial Aneurysm (2024 Edition)2024
Chinese Society of Neurology11CNKIGuidelineChinese Guidelines for the Management of Severe Stroke 20242024
Wang Zengwu et al.12CNKIExpert ConsensusChinese Expert Consensus on Hypertension Management in Stroke Patients2024
Hoh et al.13AHAGuideline2023 Guideline for the Management of Patients with Aneurysmal Subarachnoid Hemorrhage: A Guideline from the American Heart Association/American Stroke Association2023
Xu Yueqiao et al.14CNKIExpert ConsensusExpert Consensus on the Management of Severe Aneurysmal Subarachnoid Hemorrhage (2023)2023
Treggiari et al.15PubMedGuidelineGuidelines for the Neurocritical Care Management of Aneurysmal Subarachnoid Hemorrhage2023
Picetti et al.16SIAARTIExpert ConsensusEarly management of patients with aneurysmal subarachnoid hemorrhage in a hospital with neurosurgical/neuroendovascular facilities - part 12022
Picetti et al.17SIAARTIExpert ConsensusEarly management of patients with aneurysmal subarachnoid hemorrhage in a hospital with neurosurgical/neuroendovascular facilities - part 22022
Shoamanesh et al.18WSOGuidelineCanadian stroke best practice recommendations: Management of Spontaneous Intracerebral Hemorrhage, 7th Edition Update 20202021
Sandset et al.19ESOGuidelineEuropean Stroke Organisation (ESO) guidelines on blood pressure management in acute ischemic stroke and intracerebral hemorrhage2021
Zhang Tongyu et al.20CNKIGuidelineChinese Guidelines for the Diagnosis and Treatment of Ruptured Intracranial Aneurysm 20212021
Chinese Society of Neurology21CNKIGuidelineChinese Guidelines for the Diagnosis and Treatment of Subarachnoid Hemorrhage 20192019
Cho et al.22PubMedGuidelineKorean clinical practice guidelines for aneurysmal subarachnoid hemorrhage2018
Steiner et al.23ESOGuidelineEuropean Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage2014
Rordorf et al.24UpToDateClinical DecisionSpontaneous intracerebral hemorrhage: Treatment and prognosis2014
Steiner et al.25EmbaseGuidelineEuropean stroke organization guidelines for the management of intracranial aneurysms and subarachnoid hemorrhage2013

AHA, American Heart Association; CNKI, China National Knowledge Infrastructure; Embase, Excerpta Medica Database; ESO, European Stroke Organisation; SIAARTI, Italian Society of Anaesthesia, Resuscitation and Intensive Care; WSO, World Stroke Organization.

Results of quality appraisal

Among the 11 included guidelines, 10 were rated as Grade A and 1 as Grade B (Table 3).10,11,13,15,18–23,25 The quality evaluation process demonstrated excellent methodological consistency between the two independent reviewers, yielding a single-measure ICC of 0.859 (95% CI: 0.817–0.892; P < 0.001) and an average-measure ICC of 0.924 (95% CI: 0.900–0.943), confirming highly robust inter-rater agreement throughout the AGREE II evaluation process. The Grade B guideline scored poorly in “Applicability” (12.5%) and “Editorial Independence” (37.5%), which led to its downgrading. Given its methodological limitations and earlier publication date, a prudent approach was adopted when utilizing the evidence from this guideline: (1) it was never used as a primary or sole evidence source; (2) it served exclusively as supplementary validation when aligned with Grade A or more recent protocols; and (3) in cases of conflict, contemporary higher-level evidence was prioritized. Consequently, its inclusion did not compromise the reliability of the synthesized framework. Additionally, the four expert consensuses demonstrated reliable quality across their respective appraisal domains (Table 4).12,14,16,17 Crucially, the two UpToDate clinical decision entries were incorporated only after passing independent secondary validation to ensure evidence integrity.

Table 3

Quality evaluation results of guidelines (n = 11)

GuidelineScope and purposeStakeholder involvementRigor of developmentClarity of presentationApplicabilityEditorial independence≥ 60%≥ 30%Quality evaluation
Society of Neurosurgery of Chinese Medical Association1091.67%77.78%72.92%91.67%47.92%87.50%56A
Chinese Society of Neurology1191.67%83.33%77.08%94.44%50.00%100.00%56A
Hoh et al.13100.00%94.44%95.83%100.00%85.42%100.00%66A
Treggiari et al.15100.00%86.11%95.83%83.33%75.00%58.33%56A
Shoamanesh et al.1894.44%91.67%92.71%97.22%92.71%95.83%66A
Sandset et al.19100.00%83.33%86.50%91.67%52.17%95.83%56A
Zhang Tongyu et al.2086.11%63.89%62.50%83.33%43.75%70.83%56A
Neurology Branch of the Chinese Medical Association2191.67%86.11%67.71%91.67%45.83%100.00%56A
Cho et al.2291.67%61.11%70.83%75.00%29.17%70.83%55A
Steiner et al.23100.00%88.83%89.67%100.00%66.67%100.00%66A
Steiner et al.2576.19%47.83%36.50%66.67%12.50%37.50%25B

AGREE II, Appraisal of Guidelines for Research and Evaluation II; CI, confidence interval; ICC, intraclass correlation coefficient.

Table 4

Quality appraisal results of expert consensuses (n = 4)

Evaluation criteriaWang et al.12
Xu et al.14
Picetti et al.16
Picetti et al.17
P1P2P1P2P1P2P1P2
1. Is the source of the opinion clearly identified?YesYesYesYesYesYesYesYes
2. Does the opinion originate from influential experts in the field?YesYesYesYesYesYesYesYes
3. Are the views presented centered on the interests of the population studied?YesYesYesYesYesYesYesYes
4. Are the stated conclusions based on analytical results? Is the expression of the opinion logical?YesYesYesYesYesYesYesYes
5. Is reference made to existing other literature?YesYesYesYesYesYesYesYes
6. Is there any inconsistency between the proposed views and previous literature?NoYesNoNoUnclearYesNoNo
Inclusion decisionIncludedIncludedIncludedIncluded

Inconsistent ratings on item 6 were generated by two independent reviewers (JZ and HW). Thorough discussion failed to reach a consensus, so a third senior researcher (Xuan Tan) independently reviewed all full texts and provided the final arbitration judgment. All four expert consensus papers were retained following this unified decision.

Evidence synthesis

Through evidence extraction and synthesis, a summary of evidence on blood pressure management in patients with ruptured IAs was ultimately developed, encompassing 6 core clinical domains, 11 secondary subtopics, and exactly 32 recommendations (Table 1). Among these 32 synthesized recommendations, 23 (71.9%) were based on direct evidence for aSAH and ruptured IAs, forming the primary clinical framework. The remaining 9 (28.1%) were indirect evidence extracted from guidelines on neurocritical care, intracerebral hemorrhage, and acute ischemic stroke to compensate for the lack of disease-specific evidence. According to the JBI evidence grading system,28 20 recommendations corresponded to Level 1 evidence, 5 to Level 2, 2 to Level 3, and 5 to Level 5. In terms of recommendation strength, 25 items were rated Grade A and 7 items were rated Grade B.

Discussion

This evidence summary constructs a structured clinical framework for periprocedural blood pressure management in patients with ruptured IAs, synthesized from high-quality evidence across six core clinical domains. Optimal blood pressure control in this patient group cannot rely on static target values alone; it demands dynamic, individualized care delivered by multidisciplinary teams, with nurses taking a central role in daily clinical work. A core principle of safe blood pressure regulation is to balance the prevention of severe rebleeding prior to aneurysm repair and the preservation of cerebral perfusion to lower the risk of secondary ischemia. The results presented here help shift routine bedside care from passive response to standardized, evidence-led prevention, offering practical guidance for clinical nurses and facilitating unified blood pressure management strategies for patients with ruptured IAs.

Synthesized evidence indicates that establishing structured interdisciplinary coordination networks and deploying specialized neurocritical care environments form the absolute cornerstone for optimizing systemic hemodynamic profiles. Integrating advanced neurosurgical expertise, emergency triage pathways, and specialized stroke ward monitoring workflows significantly streamlines hyperacute therapeutic decision-making and mitigates critical operational delays. Beyond executing prescribed pharmacological titrations, nursing professionals bridge diverse medical specialties through continuous neurological surveillance, proactive symptom tracking, and structured family communication.

However, escalated bedside nursing workloads and heterogeneous clinical training levels remain key operational challenges that may constrain the practical efficacy of these structured care models.29 Future investigative efforts should focus on quantifying the long-term clinical impacts of nurse-led collaborative pathways and exploring artificial intelligence-driven alert systems to support clinical decision entries in low-resource settings. Notably, the operational capacity to implement comprehensive multispecialty teams and dedicated stroke units varies significantly across levels of healthcare in China. In resource-limited primary healthcare institutions, specialized workflows should prioritize the institutionalization of rapid transfer pathways alongside the core competency of nursing staff in executing noninvasive monitoring, basic life support, and structured initial triage. This stratified approach ensures the reliable execution of essential hemodynamic management components under constrained clinical conditions.

Individualized blood pressure targets are essential for implementing these recommendations in clinical practice. Given that a substantial proportion of patients with intracranial vascular rupture present with secondary chronic hypertensive conditions,7 customizing blood pressure parameters is vital to maintain an intricate equilibrium between preventing paroxysmal re-rupture and safeguarding sufficient cerebral perfusion.30,31 Grounded in our synthesized evidence framework, the nursing cohort plays an indispensable role in navigating these therapeutic trade-offs. It is worth noting that some underlying guidance within our matrix exhibits dynamic clinical discrepancies or relies on classic historical milestones. While these foundational documents remain valuable for benchmarking baseline neurovascular care, their recommendations regarding hyperacute titration timing and upper boundary alerts must be carefully cross-referenced with modern authoritative updates, such as the 2023 AHA/American Stroke Association (ASA) guidelines, to avoid clinical lag. Furthermore, the overt contradictions between intensive, immediate blood pressure lowering that traditionally derived from spontaneous intracerebral hemorrhage protocols and gradual, stabilized SBP reduction mandated for unoccluded ruptured aneurysms require advanced nursing acumen. Rather than viewing these divergent recommendation lines as overlapping or incompatible, frontline nursing workflows must decipher their heterogeneous pathophysiological rationales. Intensive early titration targets rapid hemostasis to halt hematoma expansion in intraparenchymal bleeding, whereas unsecured aneurysms dictate a controlled, gentle downregulation to protect collateral circulation. Implementing nurse-led, individualized assessment pathways effectively bridges these conceptual conflicts, transforming rigid guideline numbers into precise, dynamic autoregulation-guided bedside surveillance.32 This deliberate stratification ensures that direct ruptured aneurysm data provides the absolute core framework for baseline care, while indirect items adapted from related neurocritical care contexts serve exclusively as conditional, supplementary guidance when disease-specific literature is absent.

To translate this stratified evidence framework into rigorous bedside practice, systematic physiological monitoring and standardized vasoactive drug titration stand as core components of neuro-intensive nursing care. Utilizing continuous invasive intra-arterial tracking combined with an immediate 15-min tracking frequency during the initial 24 h serves to effectively stabilize hyperacute hemodynamic variability and prevent blind spots in blood pressure detection. Continuous blood pressure surveillance is essential to capture pathological blood pressure variability, which functions as an independent neurovascular risk factor, while rational pharmacological selection dictates a comprehensive appraisal of cerebrovascular selectivity, pharmacokinetic properties, and blood-brain barrier permeability.

In this clinical domain, critical care nursing competencies are dual-faceted. Technically, nurses must master the maintenance of transducer systems, accurately interpret intra-arterial waveform variances, and perform rapid bedside troubleshooting. Clinically, they bear the responsibility for the microtitration of high-alert continuous infusions, ensuring precise rate adjustments by prioritizing short-acting, highly titratable intravenous agents (e.g., nicardipine or labetalol) while routinely avoiding potent cerebral vasodilators such as nitroprusside or nitroglycerin to prevent iatrogenic ICP spikes. Standardized, nurse-led care pathways significantly enhance compliance with target-range protocols and prevent iatrogenic pressure fluctuations secondary to environmental or procedural triggers.33

Accordingly, specialized nursing workflows should focus on four areas: (1) executing continuous hemodynamic tracking and distinguishing pathologic waveform alterations; (2) calibrating precise continuous infusion rates of high-alert antihypertensives while proactively screening for systemic hypotension (Items 10–12); (3) institutionalizing systematic nonpharmacological bundles, including strict bed rest, environmental management, and targeted sedation/analgesia to prevent straining; and (4) conducting serial neurological status grading to guide interdisciplinary crisis decision-making. We recommend that clinical institutions establish competency-based training programs addressing these specialized dimensions to elevate advanced nursing performance in invasive monitoring while integrating computerized clinical decision-support architectures to pioneer an integrated “monitoring-alert-intervention” management model.

Synthesized protocols confirm that consistent oral nimodipine administration represents the standard pharmacological baseline to suppress cerebral vasospasm trajectories. However, in higher-grade aSAH patient cohorts where heavy sedation limits serial clinical examinations, the implementation of objective screening tools becomes mandatory. Utilizing transcranial Doppler scans, scheduled daily or every other day during the critical risk window, provides a reliable bedside method to track hemodynamic velocity changes before irreversible tissue ischemia develops. Frontline nursing responsibilities must shift from passive event observation to systematic tracking using validated grading systems, including the Glasgow Coma Scale and the National Institutes of Health Stroke Scale scores. Implementing these standardized nursing tracking tools ensures early detection of microfluctuations in neurological performance, enabling rapid interdisciplinary crisis intervention.

Parallel to this active neurological surveillance, managing circulatory volume represents another vital therapeutic component and requires a strict departure from traditional empirical fluid-loading practices. The routine implementation of prophylactic traditional “3H therapy” is systematically discouraged due to associated cardiopulmonary risks and the lack of clinical benefit in asymptomatic cohorts.34 Current evidence mandates the maintenance of strict normovolemia to protect cerebral perfusion without triggering intracranial pressure spikes. To achieve this balance, clinical protocols must integrate subjective physical evaluations with objective hemodynamic monitoring parameters. Specialized nursing actions are pivotal in this domain; rather than adhering to rigid, static fluid schedules, critical care nurses must balance fluid inputs and outputs through real-time parameters, preserving the delicate equilibrium between cerebral blood flow and optimal systemic volume.

Once hemodynamic stability is attained and the ruptured aneurysm receives definitive treatment, evidence-based nursing priorities shift from urgent in-hospital intervention to standardized long-term follow-up planning, a vital segment of continuous patient care. Securing the ruptured aneurysm via endovascular coiling or microsurgical clipping does not entirely eliminate the lifetime risk of coil compaction, neck remnants, or de novo aneurysm development. The synthesized evidence establishes a clear, standardized chronological timeline for postoperative neuroimaging follow-up, starting with an initial radiological reassessment at 3 to 6 months. This is followed by serial annual surveillance at years 1, 2, 3, and 5, before safely transitioning to a long-term maintenance window of every 3 to 5 years. Specialized nursing roles should focus on creating formalized outpatient navigation tracks and ensuring reliable family screening, bridging hyperacute critical care with structured long-term neurological health preservation.

Limitations

This study developed a framework for blood pressure management in patients with ruptured IAs based on the current best available evidence; however, several limitations should be acknowledged. First, some recommendations were derived from international guidelines, which may require adaptation to align with local healthcare resources and nursing practice characteristics when applied in China. Second, the literature search was restricted to Chinese and English databases, which may have introduced language bias. Additionally, traditional quality appraisal tools were not independently applied to UpToDate entries due to their dynamically updated nature; however, this system-inherent limitation was rigorously managed by our secondary verification of its referenced source guidelines. Finally, the unique role of nursing in blood pressure management warrants further investigation through original studies. Future research should focus on developing nursing protocols tailored to the Chinese clinical context and rigorously evaluating their effectiveness through well-designed interventional studies, thereby further clarifying the contribution and value of nursing in blood pressure management for patients with ruptured IAs.

Conclusions

This study systematically synthesized 32 items of best evidence to establish a structured, high-density framework for optimizing periprocedural blood pressure management in patients with ruptured IAs. The resulting evidence matrix is broadly aligned with six core clinical domains: establishing multidisciplinary networks, calibrating individualized blood pressure targets, ensuring precision hemodynamic monitoring, executing targeted complication prevention, structuring fluid therapy strategies, and scheduling longitudinal follow-up. Furthermore, this framework helps operationalize the specialized roles of neurocritical care nurses in active clinical triage, real-time arterial tracking, proactive delayed cerebral ischemia surveillance, and long-term surveillance. These synthesized findings provide an evidence-based framework to guide standardized nursing-led blood pressure management protocols, offering an actionable pathway to mitigate rebleeding risks and improve clinical outcomes in this high-acuity patient population.

Declarations

Acknowledgement

We thank all members of the multidisciplinary team for their valuable contributions to this study.

Ethical statement

This study constitutes an evidence summary based on existing published literature. As it did not involve human or animal participants, nor entail the collection of primary data, ethical approval was not required. All procedures were performed in accordance with applicable reporting standards and guidelines.

Data sharing statement

The literature search matrices, customized database query formulations, and appraisal dynamics data used to support the findings of this study are included within the supplementary information file(s) (Supplementary File 1). No additional data are available.

Funding

This work was supported by the Evidence Translation and Application Program of the Fudan University Center for Evidence-based Nursing (Grant No. Fudanebn202505).

Conflict of interest

The authors declare that there is no conflict of interest.

Authors’ contributions

Study conception and design, evidence analysis and summary, and manuscript drafting (HW, JZ, XT, LS), literature search and screening (SZ, LQ, YZ, QH, XW), literature quality evaluation and data extraction (HW, XT, YZ, DL, HP), manuscript review, critical revision, funding acquisition, and resource coordination (XT, LS). All authors read and approved the final manuscript.

References

  1. Marbacher S, Wanderer S, Strange F, Grüter BE, Fandino J. Saccular Aneurysm Models Featuring Growth and Rupture: A Systematic Review. Brain Sci 2020;10(2):101 View Article PubMed/NCBI
  2. Expert Consensus Working Group on Microsurgical Treatment of Intracranial Aneurysms. Expert Consensus on Microsurgical Treatment of Intracranial Aneurysms (2025 Edition) (in Chinese). Chin J Surg 2025;63(3):187-202 View Article
  3. Ingall T, Asplund K, Mähönen M, Bonita R. A multinational comparison of subarachnoid hemorrhage epidemiology in the WHO MONICA stroke study. Stroke 2000;31(5):1054-1061 View Article PubMed/NCBI
  4. Sonesson B, Kronvall E, Säveland H, Brandt L, Nilsson OG. Long-term reintegration and quality of life in patients with subarachnoid hemorrhage and a good neurological outcome: findings after more than 20 years. J Neurosurg 2018;128(3):785-792 View Article PubMed/NCBI
  5. Nussbaum ES, Mikoff N, Paranjape GS. Cognitive deficits among patients surviving aneurysmal subarachnoid hemorrhage. A contemporary systematic review. Br J Neurosurg 2021;35(4):384-401 View Article PubMed/NCBI
  6. Fernando SM, Reardon PM, Dowlatshahi D, English SW, Thavorn K, Tanuseputro P, et al. Outcomes and Costs of Patients Admitted to the ICU Due to Spontaneous Intracranial Hemorrhage. Crit Care Med 2018;46(5):e395-e403 View Article PubMed/NCBI
  7. Huang QY, Huang Q, Lin SW, Wang F, Sun Y, Zeng YL, et al. Prognostic factors affecting the ruptured intracranial aneurysms: A 9-year multicenter study in Fujian, China. Medicine (Baltimore) 2023;102(40):e34893 View Article PubMed/NCBI
  8. Zhu Z, Hu Y, Xing WJ, Zhou YF, Gu Y. Composition of different types of evidence-based questions (in Chinese). J Nurs Train 2017;32(21):1991-1994 View Article
  9. Singer RJ, Ogilvy CS, Rordorf G. In: Biller J, Rabinstein AA (eds). Aneurysmal subarachnoid hemorrhage: Treatment and prognosis. Waltham: UpToDate, Inc; 2025. Available from: https://www.uptodate.com Accessed June 30, 2025
  10. Society of Neurosurgery of Chinese Medical Association; Society of Cerebrovascular Surgery of Chinese Stroke Association; National Center for Neurological Disorders; National Clinical Research Center for Neurological Diseases. Chinese guideline for the clinical management of patients with ruptured intracranial aneurysms (2024) (in Chinese). Zhonghua Yi Xue Za Zhi 2024;104(21):1940-1971 View Article PubMed/NCBI
  11. Chinese Society of Neurology, Chinese Stroke Society. Chinese guidelines for the management of severe stroke 2024 (in Chinese). Chin J Neurol 2024;57(7):698-714 View Article
  12. Wang ZW, Wang S, Feng C, Zheng K, Huang R, Guo H, et al. Chinese expert consensus on hypertension management in stroke patients (in Chinese). Chin J Stroke 2024;19(6):672-698 View Article
  13. Hoh BL, Ko NU, Amin-Hanjani S, Chou S, Cruz-Flores S, Dangayach NS, et al. 2023 guideline for the management of patients with aneurysmal subarachnoid hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke 2023;54(7):e314-e370 View Article
  14. Xu YQ, Shi GZ, Wei JJ, Qu X, Qi M, Zhao H. Expert consensus on the management of severe aneurysmal subarachnoid hemorrhage (2023) (in Chinese). Chin J Cerebrovasc Dis 2023;20(2):126-145 View Article
  15. Treggiari MM, Rabinstein AA, Busl KM, Caylor MM, Citerio G, Deem S, et al. Guidelines for the Neurocritical Care Management of Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 2023;39(1):1-28 View Article PubMed/NCBI
  16. Picetti E, Barbanera A, Bernucci C, Bertuccio A, Bilotta F, Boccardi EP, et al. Early management of patients with aneurysmal subarachnoid hemorrhage in a hospital with neurosurgical/neuroendovascular facilities: a consensus and clinical recommendations of the Italian Society of Anesthesia and Intensive Care (SIAARTI)-Part 1. J Anesth Analg Crit Care 2022;2(1):13 View Article PubMed/NCBI
  17. Picetti E, Barbanera A, Bernucci C, Bertuccio A, Bilotta F, Boccardi EP, et al. Early management of patients with aneurysmal subarachnoid hemorrhage in a hospital with neurosurgical/neuroendovascular facilities: a consensus and clinical recommendations of the Italian Society of Anesthesia and Intensive Care (SIAARTI)-part 2. J Anesth Analg Crit Care 2022;2(1):21 View Article PubMed/NCBI
  18. Shoamanesh A, Patrice Lindsay M, Castellucci LA, Cayley A, Crowther M, de Wit K, et al. Canadian stroke best practice recommendations: Management of Spontaneous Intracerebral Hemorrhage, 7th Edition Update 2020. Int J Stroke 2021;16(3):321-341 View Article PubMed/NCBI
  19. Sandset EC, Anderson CS, Bath PM, Christensen H, Fischer U, Gąsecki D, et al. European Stroke Organisation (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage. Eur Stroke J 2021;6(2):XLVIII-LXXXIX View Article PubMed/NCBI
  20. Zhang T, Liu P, Xiang S, Feng H, Wang T, Wang K, et al. Chinese guidelines for the diagnosis and treatment of ruptured intracranial aneurysm 2021 (in Chinese). Chin J Cerebrovasc Dis 2021;18(8):546-574 View Article
  21. Chinese Society of Neurology; Chinese Stroke Society; Neurovascular Intervention Group of Chinese Society of Neurology. Chinese guidelines for the diagnosis and treatment of subarachnoid hemorrhage 2019 (in Chinese). Chin J Neurol 2019;52(12):1006-1021 View Article
  22. Cho WS, Kim JE, Park SQ, Ko JK, Kim DW, Park JC, et al. Korean Clinical Practice Guidelines for Aneurysmal Subarachnoid Hemorrhage. J Korean Neurosurg Soc 2018;61(2):127-166 View Article PubMed/NCBI
  23. Steiner T, Al-Shahi Salman R, Beer R, Christensen H, Cordonnier C, Csiba L, et al. European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage. Int J Stroke 2014;9(7):840-855 View Article PubMed/NCBI
  24. Rordorf G, McDonald CT. In: Edlow JA, Rabinstein AA, Tung GA, Cucchiara BL (eds). Spontaneous intracerebral hemorrhage: Acute treatment and prognosis. Waltham: UpToDate, Inc; 2014. Available from: https://www.uptodate.com Accessed June 30, 2025
  25. Steiner T, Juvela S, Unterberg A, Jung C, Forsting M, Rinkel G, et al. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis 2013;35(2):93-112 View Article PubMed/NCBI
  26. Xie LM, Wang WY. A brief introduction to Appraisal of Guidelines for Research and Evaluation II (in Chinese). Zhong Xi Yi Jie He Xue Bao 2012;10(2):160-165 View Article PubMed/NCBI
  27. McArthur A, Klugárová J, Yan H, Florescu S. Innovations in the systematic review of text and opinion. Int J Evid Based Healthc 2015;13(3):188-195 View Article PubMed/NCBI
  28. Wang CQ, Hu Y. JBI Evidence Pre-Grading and Evidence Recommendation Level System (2014 edition) (in Chinese). J Nurs Train 2015;30(11):964-967 View Article
  29. Ross P, Howard B, Ilic D, Watterson J, Hodgson CL. Nursing workload and patient-focused outcomes in intensive care: A systematic review. Nurs Health Sci 2023;25(4):497-515 View Article PubMed/NCBI
  30. Calviere L, Gathier CS, Rafiq M, Koopman I, Rousseau V, Raposo N, et al. Rebleeding After Aneurysmal Subarachnoid Hemorrhage in Two Centers Using Different Blood Pressure Management Strategies. Front Neurol 2022;13:836268 View Article PubMed/NCBI
  31. Vergouwen MDI, Rinkel GJE. Emergency Medical Management of Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 2023;39(1):51-58 View Article PubMed/NCBI
  32. Gomez JR, Bhende BU, Mathur R, Gonzalez LF, Shah VA. Individualized autoregulation-guided arterial blood pressure management in neurocritical care. Neurotherapeutics 2025;22(1):e00526 View Article PubMed/NCBI
  33. Vay-Demouy J, Lelong H, Blacher J. Impact of nurse-led interventions with prescriptive authority on blood pressure control in hypertension management: a systematic review and meta-analysis. BMC Nurs 2025;24(1):763 View Article PubMed/NCBI
  34. Thilak S, Brown P, Whitehouse T, Gautam N, Lawrence E, Ahmed Z, et al. Diagnosis and management of subarachnoid haemorrhage. Nat Commun 2024;15(1):1850 View Article PubMed/NCBI
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Wang H, Zhang J, Tan X, Sun L, Qu L, Zhan Y, et al. Evidence Summary for Blood Pressure Management in Patients with Ruptured Intracranial Aneurysms: Implications for Clinical Nursing Practice. Neurosurgical Subspecialties. Published online: Jun 29, 2026. doi: 10.14218/NSSS.2026.00007.
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Article History
Received Revised Accepted Published
April 3, 2026 May 22, 2026 June 15, 2026 June 29, 2026
DOI http://dx.doi.org/10.14218/NSSS.2026.00007
  • Neurosurgical Subspecialties
  • eISSN 3067-6150
  • © 2026 Xia & He Publishing Inc.
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Evidence Summary for Blood Pressure Management in Patients with Ruptured Intracranial Aneurysms: Implications for Clinical Nursing Practice

Huan Wang, Juanfang Zhang, Xuan Tan, Li Sun, Lianlian Qu, Yuxin Zhan, Sisi Zhang, Danfeng Li, Qiong He, Xiaomei Wei, Hailan Peng
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