Blood pressure and in-hospital outcomes in patients presenting with ischaemic stroke
Blood pressure and in-hospital outcomes in patients presenting with ischaemic stroke
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DOI：
10.1093/eurheartj/ehx330
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发表时间：
2017-10-01
影响因子：
39.3
通讯作者：
Bhatt, Deepak L.
中科院分区：
文献类型：
--
作者：
Bangalore, Sripal;Schwamm, Lee;Bhatt, Deepak L.
卒中后高血压与不良的短期预后相关，尽管结果一直存在矛盾。我们的目的是评估血压（BP）和急性缺血性stroke. Methods和结果的患者在医院的结果与指南，中风注册急性缺血性中风的关联。采用入院时收缩压和舒张压计算平均动脉压（MAP）和脉压（PP）。关注的结果是：住院死亡率、不能出院回家、出院时不能独立行走和溶栓治疗引起的出血并发症。共纳入309611例缺血性卒中患者。收缩压与预后呈J/U型关系。与中心参考值相比，较低和较高的收缩压值均具有较高的院内死亡风险[例如，校正的比值比（95%置信区间）（OR [CI]）= 1.16 [1.13 - 1.20]（120与150 mmHg）和1.24 [1.19 - 1.30]（200与150 mmHg），未出院回家（OR [CI]= 1.11 [1.09 - 1.13]，120 vs. 150 mmHg; 1.15 [1.12 - 1.18]，200 vs. 150 mmHg），出院时无法独立行走（120 vs. 150 mmHg和200 vs. 150 mmHg的OR [CI]= 1.16 [1.13 - 1.18]和1.09 [1.06 - 1.11]）。然而，溶栓治疗的出血并发症风险在收缩压较低时较低（120 vs. 150 mmHg的OR [CI]= 0.89 [0.83 - 0.97]），而在收缩压较高时较高（200 vs. 150 mmHg的OR [CI]= 1.21 [1.11 - 1.32]）。结果在很大程度上是相似的入院舒张压，平均动脉压，和PP。结论在缺血性脑卒中住院患者，J形，或U形的关系，观察血压变量和短期结果之间。然而，溶栓治疗的出血并发症随着血压的降低而降低。
Aims Post-stroke hypertension is associated with poor short-term outcome, although the results have been conflicting. Our objective was to evaluate the association of blood pressure (BP) and in-hospital outcomes in patients with acute ischaemic stroke.Methods and results Patients in the Get With The Guidelines-Stroke registry with acute ischaemic stroke were included. Admission systolic and diastolic BP was used to compute mean arterial pressure (MAP) and pulse pressure (PP). The outcomes of interest were: in-hospital mortality, not discharged home, inability to ambulate independently at discharge and haemorrhagic complications due to thrombolytic therapy. A total of 309 611 patients with an ischaemic stroke were included. There was a J-shaped/U-shaped relationship between systolic BP and outcomes. Both lower and higher systolic BP values, compared with a central reference value, had higher risk of in-hospital death [e.g. adjusted odds ratio (95% confidence interval) (OR[CI]) = 1.16[1.13-1.20] for 120 vs. 150 mmHg and 1.24[1.19-1.30] for 200 vs. 150 mmHg], not discharged home (OR[CI] = 1.11[1.09-1.13] for 120 vs. 150mmHg and 1.15[1.12-1.18] for 200 vs. 150 mmHg), inability to ambulate independently at discharge (OR[CI] = 1.16[1.13-1.18] for 120 vs. 150 mmHg and 1.09[1.06-1.11] for 200 vs. 150mmHg). However, risk of haemorrhagic complications of thrombolytic therapy was lower with lower systolic BP (OR[CI] = 0.89[0.83-0.97] for 120 vs. 150 mmHg), while higher with higher systolic BP (OR[CI] = 1.21[1.11-1.32] for 200 vs. 150 mmHg). The results were largely similar for admission diastolic BP, MAP, and PP.Conclusion In patients hospitalized with ischaemic stroke, J-shaped, or U-shaped relationships were observed between BP variables and short-term outcomes. However, haemorrhagic complications with thrombolytic therapy were lower with lower BP.