Blood Pressure Variability on Antihypertensive Therapy in Acute Intracerebral Hemorrhage The Stroke Acute Management With Urgent Risk-Factor Assessment and Improvement-Intracerebral Hemorrhage Study
Blood Pressure Variability on Antihypertensive Therapy in Acute Intracerebral Hemorrhage The Stroke Acute Management With Urgent Risk-Factor Assessment and Improvement-Intracerebral Hemorrhage Study
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DOI：
10.1161/strokeaha.114.005420
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发表时间：
2014-08-01
期刊：
影响因子：
8.3
通讯作者：
Toyoda, Kazunori
中科院分区：
文献类型：
--
作者：
Tanaka, Eijirou;Koga, Masatoshi;Toyoda, Kazunori
背景和目的--最近通过对急性脑出血患者强化降压试验2的事后分析，阐明了脑出血患者抗高血压治疗后早期血压（BP）变异性与临床结局之间的关系（互动2），证实使用中风急性管理与紧急风险因素评估和改善（SAMURAI）-脑出血研究队列。在一项前瞻性、多中心、观察性研究中登记了超急性（180 mm Hg）患者。所有患者均接受基于预先定义的标准化方案的抗高血压治疗，使用静脉内尼卡地平降低SBP并将其维持在120 - 160 mm Hg之间。在最初的24小时内每小时测量BP。BP变异性被确定为SD和连续变异。血压变异性与血肿扩大（>33%）、72小时内神经功能恶化和3个月时不良结局（改良兰金量表，4-6分）之间的相关性进行了评估。结果在205例患者中，33例（16%）显示血肿扩大，14例（7%）显示神经功能恶化，81例（39%）有不良结局。SBP的SD和连续变异分别为13.8（四分位距，11.5-16.8）和14.9（11.7-17.7）mmHg，舒张压的SD和连续变异分别为9.4（7.5-11.2）和13.1（11.2-15.9）mmHg。在多变量回归分析中，神经功能恶化与SBP的SD（比值比，2.75; 95%置信区间，每四分位数1.45-6.12）和SBP的连续变化（2.37; 1.32-4.83）相关，不良结局与SBP的连续变化（1.42; 1.04-1.97）相关。血肿扩大与任何BP variability. Conclusion-SBP变异性在最初24小时的急性脑出血是独立相关的神经功能恶化和不利的结果。稳定的降压治疗可改善临床结局。
Background and Purpose-The associations between early blood pressure (BP) variability and clinical outcomes in patients with intracerebral hemorrhage after antihypertensive therapy, recently clarified by a post hoc analysis of Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial 2 (INTERACT2), were confirmed using the Stroke Acute Management with Urgent Risk-factor Assessment and Improvement (SAMURAI)-intracerebral hemorrhage study cohort.Methods-Patients with hyperacute (180 mm Hg were registered in a prospective, multicenter, observational study. All patients received antihypertensive therapy based on a predefined standardized protocol to lower and maintain SBP between 120 and 160 mm Hg using intravenous nicardipine. BPs were measured hourly during the initial 24 hours. BP variability was determined as SD and successive variation. The associations between BP variability and hematoma expansion (>33%), neurological deterioration within 72 hours, and unfavorable outcome (modified Rankin Scale, 4-6) at 3 months were assessed.Results-Of the 205 patients, 33 (16%) showed hematoma expansion, 14 (7%) showed neurological deterioration, and 81 (39%) had unfavorable outcomes. The SD and successive variation of SBP were 13.8 (interquartile range, 11.5-16.8) and 14.9 (11.7-17.7) mm Hg, respectively, and those of diastolic BP were 9.4 (7.5-11.2) and 13.1 (11.2-15.9) mm Hg, respectively. On multivariate regression analyses, neurological deterioration was associated with the SD of SBP (odds ratio, 2.75; 95% confidence interval, 1.45-6.12 per quartile) and the successive variation of SBP (2.37; 1.32-4.83), and unfavorable outcome was associated with successive variation of SBP (1.42; 1.04-1.97). Hematoma expansion was not associated with any BP variability.Conclusions-SBP variability during the initial 24 hours of acute intracerebral hemorrhage was independently associated with neurological deterioration and unfavorable outcomes. Stability of antihypertensive therapy may improve clinical outcomes.