Blood pressure variability and early neurological outcomes in acute and subacute stroke in Southwestern Uganda.
Blood pressure variability and early neurological outcomes in acute and subacute stroke in Southwestern Uganda.
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DOI：
10.1016/j.ensci.2023.100482
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发表时间：
2023-12
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影响因子：
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通讯作者：
Muyingo, Anthony
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作者：
Kulaba, Nicholas;Kayanja, Adrian;Serubiri, Denis;Mukasa, Mark Kaddu;Kaddumukasa, Martin;Nakibuuka, Jane;Moore, Shirley M;Katabira, Elly T;Sajatovic, Martha;O'Carroll, Cumara B;Muyingo, Anthony
更大的血压变异性对中风后的临床结果有不利影响;其影响是有争议的，尚未在撒哈拉以南非洲（SSA）进行评估。我们对在单侧神经功能缺损发作后7天内入住三级医院的经头部CT证实的缺血性和出血性卒中患者进行了前瞻性研究。采用改良兰金量表（mRS）评分，计算第0天至第7天收缩压和舒张压的变异指数、标准差（SD）和变异系数（CV）。采用线性回归法确定卒中后14天死亡率的指数系数。在120例患者中，51.7%为女性，52.5%患有缺血性卒中，总体中位年龄为65岁（IQR 54-80）。20例（16.7%）患者在中位生存期7天内死亡，32例（26.7%）患者在卒中后第14天死亡。出血性卒中患者的总体SDSBP为16.44 mmHg，而缺血性卒中患者的总体SDSBP为14.05 mmHg。在缺血性卒中患者中，SDSBP的校正系数为1，p = 0.004，C·I：1.01-1.04，NIHSS的校正系数为1，p = 0.019，C·I：1.00-1.03，而在出血性卒中患者中，SDSBP的校正系数为1，p = 0.045，C·I：1.00-1.04，NIHSS的校正系数为1，p ≤0.001，C·I：1.01-1.03。在我们的研究中，血压变异性（BPV）和卒中严重程度量表指数增加与所有卒中患者的早期死亡率独立相关。我们建议未来的研究，以评估是否在撒哈拉以南非洲地区的中风患者中控制BPV可以降低死亡率。乌干达西南部的急性和亚急性中风患者有高血压变异。高血压变异与乌干达患者不良卒中临床结局相关脑卒中后血压变异性与神经功能预后的关系不是线性的。不能排除血压变异性与结局之间的反向因果关系。严重的中风与自主神经系统的严重紊乱有关。
Greater blood pressure variability has detrimental effects on clinical outcome after a stroke; its effects are controversial and have not been evaluated in Sub-Saharan Africa (SSA). We conducted a prospective study of patients with CT head confirmed ischemic and hemorrhagic strokes admitted to a tertiary hospital within 7 days of onset of unilateral neurological deficits. Blood pressure variability indices, standard deviation (SD) and coefficient of variation (CV) of systolic and diastolic blood pressure between day 0 and day 7, were calculated with a subsequent modified Rankin Scale (mRS) score on day 14 post-stroke. Linear regression was performed to determine the exponential coefficients of mortality at 14 days post- stroke. Out of 120 patients, 51.7% were female, 52.5% had ischemic stroke and the overall median age was 65 (IQR 54–80) years. Twenty (16.7%) patients died within a median survival time of 7 days, while 32 (26.7%) died by day 14 post-stroke. Patients with hemorrhagic stroke had an overall SDSBP of 16.44 mmHg while those with ischemic stroke had an overall SDSBP of 14.05 mmHg. In patients with ischemic stroke, SDSBP had adjusted coefficients of 1, p = 0.004 with C·I: 1.01–1.04 and NIHSS had adjusted coefficients of 1, p = 0.019 with C·I: 1.00–1.03 while in patients with hemorrhagic stroke, SDSBP had adjusted coefficients of 1, p = 0.045 with C·I: 1.00–1.04 and NIHSS had adjusted coefficients of 1, p ≤0.001 with C·I: 1.01–1.03. Exponential increase in Blood Pressure Variability (BPV) and stroke severity scale were independently associated with early mortality among all stroke patients in our study. We recommend future studies to evaluate whether controlling BPV among patients with stroke in Sub-Saharan Africa can reduce mortality. Patients with acute and subacute stroke in southwestern Uganda have high blood pressure variations. High blood pressure variations are associated with poor stroke clinical outcomes in Ugandan patients. Association of blood pressure variability with neurological outcomes after stroke is not linear. Reverse causality between blood pressure variability and outcome cannot be excluded. Severe stroke is associated with greater disturbance in the autonomic nervous system.