Increased blood pressure variability during the subacute phase of ischemic stroke is associated with poor functional outcomes at 3 months
Increased blood pressure variability during the subacute phase of ischemic stroke is associated with poor functional outcomes at 3 months
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DOI：
10.1038/s41598-020-57661-z
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发表时间：
2020-01-21
影响因子：
4.6
通讯作者：
Maruyama, Hirofumi
中科院分区：
文献类型：
--
作者：
Naito, Hiroyuki;Hosomi, Naohisa;Maruyama, Hirofumi
到目前为止，众所周知，血压变异性增加可能会加剧卒中结局。急性期血压受脑卒中反应性高血压和内源性血压反应性的共同影响。因此，我们的目的是评估在反应性高血压消退后的亚急性期缺血性卒中患者中使用动态血压监测3个月时血压变异性与结局之间的相关性。我们回顾性研究了626例急性缺血性卒中患者，这些患者在卒中亚急性期（中位发病时间为9天）接受了24小时动态血压监测。通过评估收缩压和舒张压的标准差和变异系数来评价血压的变异性。主要结局是3个月时的功能状态。不良预后定义为改良兰金量表评分≥ 3分，良好预后定义为≤ 2分。我们评估了497例患者（79.4%）3个月时的功能预后。平均收缩压和舒张压水平与功能结局无关。多变量分析显示，收缩压和舒张压标准差、舒张压变异系数和晨峰血压的增加与不良结局相关。缺血性卒中亚急性期的血压变异性可作为急性缺血性卒中患者3个月时功能预后不良的有用预后指标。
Thus far, it is well known that increased blood pressure variability may exacerbate stroke outcomes. Blood pressure in the acute phase would be influenced by both reactive hypertension to stroke and intrinsic blood pressure reactivity. Thus, we aimed to evaluate the association between blood pressure variability and outcomes at 3 months using ambulatory blood pressure monitoring in ischemic stroke patients in the subacute phase after reactive hypertension subsided. We retrospectively examined 626 consecutive patients with acute ischemic stroke who underwent 24-hour ambulatory blood pressure monitoring during the subacute phase of stroke (median, 9 days from onset). The variability in blood pressure was evaluated by assessing the standard deviation and coefficient of variation of systolic and diastolic blood pressure. The primary outcome was functional status at 3 months. A poor outcome was defined as a modified Rankin scale score of 3 or more and a good outcome as 2 or less. We assessed the functional outcome at 3 months in 497 patients (79.4%). The mean systolic and diastolic blood pressure levels were not associated with functional outcome. The multivariable analysis revealed that increases in the standard deviations of systolic and diastolic blood pressure, coefficient of variation of diastolic blood pressure, and morning blood pressure surge were associated with poor outcome. Blood pressure variability during the subacute phase of ischemic stroke can be a useful prognostic indicator of poor functional outcome at 3 months in patients with acute ischemic stroke.