Long-Term Outcomes in Patients With Hemorrhagic Moyamoya Disease Combined With Hypertension After Encephaloduroarteriosynangiosis

Background Although hypertension is prevalent in adults with moyamoya disease (MMD) and intracranial hemorrhage significantly worsens prognosis, the impact of hypertension on long-term outcomes after encephaloduroarteriosynangiosis in hemorrhagic MMD remains unclear; this retrospective cohort study used propensity score matching to compare outcomes between hypertensive and nonhypertensive patients and preliminarily assess the role of blood pressure management. Methods After propensity score matching, long-term outcomes post- encephaloduroarteriosynangiosis in patients with hemorrhagic MMD with hypertension from January 2010 to December 2018 were analyzed. The clinical and radiological data were collected. Kaplan-Meier curves evaluated the relationship between recurrence-free survival, overall survival (OS), and hypertension. Univariate and multivariate Cox regression assessed independent factors influencing hematoma recurrence-free survival and OS. Subgroup analysis of patients with hemorrhagic MMD with hypertension assessed the impact of different blood management on long-term outcomes. Results Kaplan-Meier curves showed a significant correlation between hypertension and decreased hematoma recurrence-free survival (P=0.004) and OS (P=0.014) during follow-up. The 5-year recurrence-free survival rate did not significantly differ between hypertensive and nonhypertensive groups (P=0.77). Hypertension was associated with reduced 10-year hematoma recurrence-free survival (P=0.004) and OS (P=0.014). In multivariate analysis, hypertension (P=0.015), perioperative complications (P=0.003), and choroidal anastomosis (P=0.0008) significantly influenced hematoma recurrence-free survival. Analysis of OS revealed significant differences for hypertension (P=0.018), follow-up duration (P<0.001), choroidal anastomosis (P=0.041), and initial mRS (P<0.001). Subgroup analysis showed that optimal blood pressure management significantly reduced hematoma recurrence (P=0.049) but did not improve OS (P=0.31). Conclusions This study highlights significant differences in hematoma recurrence-free survival and OS between patients with hemorrhagic MMD with and without hypertension. A subgroup analysis of those with hypertension showed that optimal blood pressure control notably lowered hematoma recurrence but did not improve OS. For patients with hemorrhagic MMD with hypertension, optimizing blood pressure alone may be insufficient, emphasizing the importance of personalized integrated strategies for this patient subgroup.