Resistant Hypertension after Hypertensive Intracerebral Hemorrhage Is Associated with More Medical Interventions and Longer Hospital Stays without Affecting Outcome.
Resistant Hypertension after Hypertensive Intracerebral Hemorrhage Is Associated with More Medical Interventions and Longer Hospital Stays without Affecting Outcome.
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DOI：
10.3389/fneur.2017.00184
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发表时间：
2017
影响因子：
3.4
通讯作者：
Yu W
中科院分区：
文献类型：
--
作者：
Hong D;Stradling D;Dastur CK;Akbari Y;Groysman L;Al-Khoury L;Chen J;Small SL;Yu W
高血压(HTN)是自发性脑出血(ICH)最常见的原因。本研究的目的是探讨耐药hTN在脑出血患者中的作用。我们对2013年11月至2015年10月期间在我们医疗中心连续入院的所有ICH患者进行了回顾性研究。比较难治性HTN患者(需服用4种或4种以上抗高血压药物以维持收缩压)和缓解性HTN患者(需服用3种或3种以下抗高血压药物)的临床特点。152例高血压性脑出血患者中，48例(31.6%)出现难治性HTN。耐药的HTN与较高的体重指数和蛋白尿独立相关。与反应组相比，难治性HTN患者的初始血压更高，对呼吸机支持、血肿清除、高渗盐水治疗和尼卡地平输注的需求更大。耐药性HTN增加了重症监护病房的住院时间(4.2vs2.1 天；p = 0.007)和住院时间(11.5vs7.0 天；p = 0.003)。多因素回归分析显示，在ICU中，收缩压和140 mm Hg的收缩压和尼卡地平的输注时间与LOS独立相关。两组在出院时血肿扩大和功能预后方面无显著差异。脑出血患者的难治性HTN与更多的医疗干预和更长的LOS相关，而不会影响出院时的预后。
Hypertension (HTN) is the most common cause of spontaneous intracerebral hemorrhage (ICH). The aim of this study is to investigate the role of resistant HTN in patients with ICH. We conducted a retrospective study of all consecutive ICH admissions at our medical center from November 2013 to October 2015. The clinical features of patients with resistant HTN (requiring four or more antihypertensive agents to keep systolic blood pressure <140 mm Hg) were compared with those with responsive HTN (requiring three or fewer agents). Of the 152 patients with hypertensive ICH, 48 (31.6%) had resistant HTN. Resistant HTN was independently associated with higher body mass index and proteinuria. Compared to the responsive group, patients with resistant HTN had higher initial blood pressures and greater requirement for ventilator support, hematoma evacuation, hypertonic saline therapy, and nicardipine infusion. Resistant HTN increases length of stay (LOS) in the intensive care unit (ICU) (4.2 vs 2.1 days; p = 0.007) and in the hospital (11.5 vs 7.0 days; p = 0.003). Multivariate regression analysis showed that the rate of systolic blood pressure >140 mm Hg and duration of nicardipine infusion were independently associated with LOS in the ICU. There was no significant difference in hematoma expansion and functional outcome at hospital discharge between the two groups. Resistant HTN in patients with ICH is associated with more medical interventions and longer LOS without effecting outcome at hospital discharge.