Hypertension History Shows No Significant Link to Aneurysm Recurrence After Coiling

Patients with ruptured or unruptured brain aneurysms treated with coils or other endovascular devices often face a worrying question: will the aneurysm come back? A new systematic review and meta-analysis from Xuzhou Medical University, published in Frontiers in Neurology, has examined one of the most commonly suspected culprits — high blood pressure — and found that the evidence linking a hypertension diagnosis to aneurysm recurrence after treatment is far weaker than many clinicians assume.

The research team, led by Weiyuan Pan, Yu Xu and Heng Gao, searched PubMed/MEDLINE, Ovid MEDLINE and Embase from database inception through April 2026. Their goal was twofold: to quantify whether study-defined or history-based hypertension predicts recurrence, recanalization, reperfusion or the need for repeat treatment after endovascular aneurysm repair, and to separately review indirect evidence on achieved blood pressure, blood pressure variability and computational fluid dynamics studies of aneurysm hemodynamics.

Thirty-one studies met the inclusion criteria. For the primary quantitative analysis, eight studies provided extractable two-by-two data covering 2,442 observations: 1,231 patients in the hypertension or high blood pressure status group and 1,211 in the non-hypertension group. Across these cohorts, 559 recurrence-related events were recorded — 242 among those with hypertension and 317 among those without.

Pooled using inverse-variance random-effects models with restricted maximum-likelihood estimation and Hartung-Knapp adjustment, the results showed an odds ratio of 1.36 with a 95 percent confidence interval of 0.92 to 2.00 and a p-value of 0.104, with moderate heterogeneity (I² of 31.4 percent). In plain terms, patients labeled hypertensive showed a directionally higher risk of recurrence-related outcomes, but the association did not reach statistical significance. The authors are careful not to overstate this: the finding is a trend, not a proven independent predictor.

Perhaps the most striking discovery is what the review could not find. Not a single eligible recurrence study reported outcomes according to achieved systolic or diastolic blood pressure target categories. In other words, the field has spent years asking whether patients are hypertensive on paper, while almost never measuring whether their actual post-treatment blood pressure stayed within a specific range — the very information that would be needed to recommend a recurrence-preventive target.

This distinction matters because a history-based hypertension diagnosis and achieved blood pressure are not the same exposure. A patient may carry a hypertension diagnosis yet be well controlled on medication, while another undiagnosed patient may run chronically high pressures. The review found that the available direct evidence concerns predominantly history-based hypertension status, whereas evidence on achieved blood pressure and blood pressure variability is only indirect for angiographic recurrence.

The indirect evidence itself proved too heterogeneous to pool. Studies of blood pressure variability addressed a range of different clinical outcomes, preventing quantitative synthesis, and the overlapping full and matched estimates from the Lee 2021 controlled-versus-uncontrolled hypertension analysis were presented separately rather than combined. Computational fluid dynamics studies, which model how blood flow stresses act on aneurysm walls and neck remnants, were synthesized narratively as mechanistic context rather than as clinical outcome data.

The authors’ conclusion is measured: current evidence is insufficient to establish study-defined hypertension as an independent predictor of recurrence after endovascular aneurysm treatment, and insufficient to recommend any specific blood pressure target for preventing recurrence. For a procedure whose main durability limitation remains recurrence, recanalization, reperfusion or retreatment, that is a significant gap in the literature.

The review also exposes a design problem in the existing literature. Most recurrence studies characterize blood pressure exposure as a history or study-defined diagnosis of hypertension rather than as achieved post-treatment systolic or diastolic blood pressure, and none of the eligible recurrence studies stratified outcomes by achieved blood pressure target categories. Until studies track achieved pressures and variability over time and relate those measurements directly to angiographic follow-up outcomes, the question of whether tighter blood pressure control protects a coiled aneurysm from reopening remains untested by direct evidence.

For now, the review’s takeaway is one of uncertainty rather than reassurance or alarm. The pooled estimate leaves open the possibility of a modest association, and the indirect nature of the hemodynamic and variability evidence means no firm clinical conclusion can be drawn from it. What the analysis establishes is precisely what is missing: direct, target-based blood pressure data tied to angiographic recurrence after endovascular treatment.

Subject of Research: Association between hypertension status and recurrence after endovascular treatment of intracranial aneurysms

Article Title: Blood pressure status and recurrence risk after endovascular treatment of intracranial aneurysms: a systematic review and meta-analysis with narrative synthesis of blood pressure targets and hemodynamic evidence

Article References: Pan, W., Xu, Y., & Gao, H. (2026). Blood pressure status and recurrence risk after endovascular treatment of intracranial aneurysms: a systematic review and meta-analysis with narrative synthesis of blood pressure targets and hemodynamic evidence. Frontiers in Neurology, 17, Article 1928054. https://doi.org/10.3389/fneur.2026.1928054

Image Credits: AI Generated

DOI: 10.3389/fneur.2026.1928054

Keywords: intracranial aneurysm, endovascular treatment, hypertension, recurrence, recanalization, blood pressure variability, meta-analysis, systematic review, computational fluid dynamics, coiling, blood pressure targets, reperfusion