Blood Pressure Variability Predicts Poor In-Hospital Outcome in Spontaneous Intracerebral Hemorrhage
Blood Pressure Variability Predicts Poor In-Hospital Outcome in Spontaneous Intracerebral Hemorrhage
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DOI：
10.1161/strokeaha.119.025514
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发表时间：
2019-08-01
期刊：
影响因子：
8.3
通讯作者：
Petersen, Alexander
中科院分区：
文献类型：
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作者：
Divani, Afshin A.;Liu, Xi;Petersen, Alexander
背景和目的：越来越多的证据表明，高收缩压变异性（SBPV）可能与脑出血（ICH）患者预后不良有关。我们探讨了SBPV和在医院ICH outcome.Methods之间的关联-我们收集了10年的自发性ICH患者在2个医疗系统的连续数据。记录人口统计学、病史、实验室检查、计算机断层扫描数据、住院治疗以及神经和功能评估。血压记录提取到入院后24小时。SBPV的测量采用标准差、变异系数、连续变异（SV）、极差和一个称为功能SV的新指标。SBPV对出院时功能结局的影响分别通过二分和二分改良兰金量表分类的多变量logistic和有序回归分析进行评价。在二次分析中，SBPV，高血压史和血肿扩大之间的关联进行了explored.Results-分析包括762名受试者。在logistic模型中，所有5个SBPV指数均与不良结局（改良兰金量表评分，4-6分）的概率显著相关。在有序模型中，发现SD、变异系数、范围和功能SV对不良（改良兰金量表评分，3-4）和重度/死亡（改良兰金量表评分，5-6）结局的概率具有显著影响。与未治疗的高血压队列相比，正常血压患者的所有SBPV指数均显著降低，与治疗的高血压患者相比，5个SBPV指数中有3个显著降低。与未经治疗的高血压受试者相比，仅在SV和功能性SV指数中检测到治疗后高血压受试者的平均SBPV较低（P=0.045）。没有SBPV指数显着相关的可能性血肿expansion.Conclusions-较高SBPV在入院的第一个24小时内与不利的ICH患者在医院的结果。进一步的前瞻性研究是必要的，以了解任何因果关系，以及是否控制SBPV可以改善ICH的结果。
Background and Purpose- There is increasing evidence that higher systolic blood pressure variability (SBPV) may be associated with poor outcome in patients with intracerebral hemorrhage (ICH). We explored the association between SBPV and in-hospital ICH outcome.Methods- We collected 10-years of consecutive data of spontaneous ICH patients at 2 healthcare systems. Demographics, medical history, laboratory tests, computed tomography scan data, in-hospital treatments, and neurological and functional assessments were recorded. Blood pressure recordings were extracted up to 24 hours postadmission. SBPV was measured using SD, coefficient of variation, successive variation (SV), range and 1 novel index termed functional SV. The effects of SBPV on the functional outcome at discharge were evaluated by multivariate logistic and ordinal regression analyses for dichotomous and trichotomous modified Rankin Scale categorizations, respectively. In secondary analyses, associations between SBPV, history of hypertension, and hematoma expansion were explored.Results- The analysis included 762 subjects. All 5 SBPV indices were significantly associated with the probability of unfavorable outcome (modified Rankin Scale score, 4-6) in logistic models. In ordinal models, SD, coefficient of variation, range, and functional SV were found to have a significant effect on the probabilities of poor (modified Rankin Scale score, 3-4) and severe/death (modified Rankin Scale score, 5-6) outcomes. Normotensive patients had significantly lower mean SBPV compared with the untreated-hypertension cohort for all SBPV indices and compared with treated-hypertension patients for 3 out of 5 SBPV indices. Lower mean SBPV of treated-hypertension subjects compared with untreated-hypertension subjects was only detected in the SV and functional SV indices (P=0.045). None of the SBPV indices were significantly associated with the probability of hematoma expansion.Conclusions- Higher SBPV in the first 24 hours of admission was associated with unfavorable in-hospital outcome among ICH patients. Further prospective studies are warranted to understand any cause-effect relationship and whether controlling for SBPV may improve the ICH outcome.