Blood Pressure Variability: A New Predicting Factor for Clinical Outcomes of Intracerebral Hemorrhage
Blood Pressure Variability: A New Predicting Factor for Clinical Outcomes of Intracerebral Hemorrhage
复制标题
DOI：
10.1016/j.jstrokecerebrovasdis.2020.105340
复制
发表时间：
2020-12-01
影响因子：
2.5
通讯作者：
Divani, Afshin A.
中科院分区：
文献类型：
--
作者：
Andalib, Sasan;Lattanzi, Simona;Divani, Afshin A.
自发性原发性脑出血（ICH）是一种死亡率最高的卒中亚型。高血压（BP）是非脑叶ICH的最常见原因。最近的临床试验对积极降低血压改善ICH结局的疗效尚无定论。高血压和脑出血预后之间的关系相当复杂，可能涉及绝对血压水平以外的参数。在这方面，越来越多的证据表明，血压变异性（BPV）在ICH结局中起着重要作用。不同的BPV指数已被用于预测血肿生长、神经功能恶化和功能恢复。本综述强调了BPV与患者临床结局之间关系的现有证据。我们确定了标准差（SD）、残差SD、变异系数、平均绝对变化、平均真实的变异、连续变异、使用傅立叶分析的谱分析和功能连续变异（FSV）作为评估BPV的指标。大多数研究已经证明了BPV与ICH结局的相关性，这表明在ICH患者的常规临床护理中需要监测和控制BP波动。当存在较大的受试者间变异性时，FSV是BPV的可行替代量化方法，因为其计算对BP患者特异性观察时间表差异的敏感性低于传统指数。
Spontaneous primary intracerebral hemorrhage (ICH) is a stroke subtype associated with the highest mortality rate. High blood pressure (BP) is the most common cause of non-lobar ICH. Recent clinical trials have been inconclusive regarding the efficacy of aggressive BP lowering to improve ICH outcome. The association between high BP and ICH prognosis is rather complex and parameters other than absolute BP levels may be involved. In this regard, there is accruing evidence that BP variability (BPV) plays a major role in ICH outcome. Different BPV indices have been used to predict hematoma growth, neurological deterioration, and functional recovery. This review highlights the available evidence about the relationship between BPV and clinical outcomes among patients. We identified standard deviation (SD), residual SD, coefficient of variation, mean absolute change, average real variability, successive variation, spectral analysis using Fourier analysis, and functional successive variation (FSV) as indices to assess BPV. Most studies have demonstrated the association of BPV with ICH outcome, suggesting a need to monitor and control BP fluctuations in the routine clinical care of ICH patients. When large inter-subject variability exists, FSV is a viable alternative quantification of BPV as its computation is less sensitive to differences in the patient-specific observation schedules for BP than that of traditional indices.