Intensive blood pressure control reduces the risk of progressive hemorrhage in patients with acute hypertensive intracerebral hemorrhage: A retrospective observational study
Intensive blood pressure control reduces the risk of progressive hemorrhage in patients with acute hypertensive intracerebral hemorrhage: A retrospective observational study
复制标题
强化血压控制可降低急性高血压脑出血患者进行性出血的风险：一项回顾性观察研究
DOI：
10.1016/j.clineuro.2019.02.021
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发表时间：
2019-05-01
影响因子：
1.9
通讯作者：
Hu, Jin
中科院分区：
文献类型：
--
作者：
Zhao, Jian-Lan;Du, Zhuo-Ying;Hu, Jin
目的：探讨强化血压控制对高血压和脑出血患者进行性脑出血和预后的影响。患者和方法：进行了一项回顾性研究，招募了2012年1月至2018年5月期间的659例急性出血性中风患者。2015年5月之前招募的患者接受目标收缩压水平< 180 mmHg的治疗，而2015年5月之后招募的患者接受强化血压控制治疗，目标收缩压水平在1小时内< 140 mmHg。进行单因素和多因素分析，以说明强化血压控制与进展性脑出血之间的关系。比较两组患者的死亡率、手术率、ICU住院时间、90 d改良兰金评分和严重不良事件发生率。结果：2015年5月前后分别招募了351例和308例急性高血压脑出血患者。659例患者中有111例发生了进行性脑出血。接受强化血压控制的患者显示血肿扩大率在统计学上较低（43/308，13.9% vs. 74/351，21.1%，p = 0.018）。强化血液控制组90天时的手术率和改良兰金评分在统计学上较低，而两组的死亡率、ICU住院时间和严重不良事件发生率相似。强化血压控制是预测血肿扩大的独立因素，具有更好的区分度（AUC = 0.889; 95%CI，0.859-0.917）（AUC = 0.821; 95%CI，0.791-0.852;和AUC = 0.635; 95%CI，0.588-0.682）。强化血压控制可降低急性出血性卒中患者进展性脑出血的风险并改善功能结局。
Objective: To investigate the impact of intensive blood pressure control on progressive intracerebral hemorrhage and outcome in patients with high blood pressure and intracerebral hemorrhage.Patients and methods: A retrospective study was conducted recruiting 659 patients with acute hemorrhagic stroke between Jan. 2012 and May 2018. Patients recruited before May 2015 were treated with a target systolic level of < 180 mm Hg, while those recruited after May 2015 received intensive blood pressure control treatment with a target systolic level of < 140 mm Hg within 1 h. Uni- and multi-variate analysis were conducted to illustrate the association between intensive blood pressure control and progressive intracerebral hemorrhage. Mortality, rates of operation, length of ICU stay, modified Rankin scores at 90 days, and the rate of serious adverse events were also compared between the two groups.Results: A total of 351 and 308 patients with acute hypertensive intracerebral hemorrhage were recruited before and after May 2015, respectively. Progressive intracerebral hemorrhage was identified among 111 out of 659 patients. Patients who received intensive blood pressure control showed a statistically lower rate of hematoma enlarging (43 of 308, 13.9% vs. 74 of 351, 21.1%, p = 0.018). The rates of operation and modified Rankin scores at 90 days were statistically lower with intensive blood control, while the mortality, length of ICU stay and rate of serious adverse events were similar between the two groups. Intensive BP control is an independent factor in predicting hematoma growing, with a more favorable discrimination (AUC = 0.889; 95%CI, 0.859-0.917) than other two models (AUC = 0.821; 95%CI, 0.791-0.852; and AUC = 0.635; 95%CI, 0.588-0.682).Conclusion: Intensive blood pressure control reduce the risk of progressive intracerebral hemorrhage and improved functional outcomes in patients with acute hemorrhagic stroke.