High Blood Pressure After Acute Ischemic Stroke Is Associated With Poor Clinical Outcomes Fukuoka Stroke Registry
High Blood Pressure After Acute Ischemic Stroke Is Associated With Poor Clinical Outcomes Fukuoka Stroke Registry
复制标题
DOI：
10.1161/hypertensionaha.113.02189
复制
发表时间：
2014-01-01
期刊：
影响因子：
8.3
通讯作者：
Kitazono, Takanari
中科院分区：
文献类型：
--
作者：
Ishitsuka, Koji;Kamouchi, Masahiro;Kitazono, Takanari
急性缺血性脑卒中患者卒中后血压（BP）与功能结局的关系仍存在争议。本研究的目的是阐明卒中后血压对急性缺血性卒中临床结局的影响。在福冈卒中登记处的患者中，1874例首次急性缺血性卒中（发病24小时内）的患者在发病前功能独立，前瞻性入选本研究。脑卒中后血压水平定义为发病后48小时内的平均值。研究结果是神经功能恢复良好、神经功能恶化和功能结果较差。在调整潜在混杂因素后，卒中后较高的BP水平与神经功能良好恢复的可能性较低、神经功能恶化的风险升高和功能结局较差显著相关。收缩压最高五分位数（与最低五分位数作为参考）的多变量校正比值比（95%置信区间）为：神经功能恢复良好为0.51（0.37-0.71），神经功能恶化为1.92（1.15-3.27），功能不良为2.51（1.69-3.74）。当我们应用卒中后舒张压或脉压时，也观察到类似的相关性。没有证据表明，J曲线现象，观察到每一个协会。这些结果表明，卒中后高血压与急性缺血性卒中患者的不良临床结局显著相关。卒中后血压水平与临床结局之间无J曲线现象。
The relationship between the poststroke blood pressure (BP) and functional outcomes in patients with acute ischemic stroke is still controversial. The aim of the present study was to elucidate the impact of the poststroke BP on the clinical outcomes of acute ischemic stroke. Among the patients in the Fukuoka Stroke Registry, 1874 patients with first-ever acute ischemic stroke (within 24 hours of onset) who had been functionally independent before onset were prospectively enrolled in the present study. The poststroke BP levels were defined as the average values during the 48 hours after onset. The study outcomes were a good neurological recovery, neurological deterioration, and a poor functional outcome. The higher poststroke BP levels were significantly associated with a lower probability of a good neurological recovery and elevated risks of neurological deterioration and a poor functional outcome after adjusting for potential confounding factors. The multivariate-adjusted odds ratios (95% confidence interval) in the highest quintile of systolic BP (versus the lowest quintile as a reference) were 0.51 (0.37-0.71) for a good neurological recovery, 1.92 (1.15-3.27) for neurological deterioration, and 2.51 (1.69-3.74) for a poor functional outcome. Similar associations were observed when we applied the poststroke diastolic BP or pulse pressure. No evidence of the J-curve phenomenon was observed for each association. These results suggest that a high poststroke BP was significantly associated with unfavorable clinical outcomes in patients with acute ischemic stroke. There was no evidence of the J-curve phenomenon between the poststroke BP levels and the clinical outcomes.