Blood Pressure Variability and Ischemic Stroke Outcome (BP-VISO)

血压变异性和缺血性中风结果 (BP-VISO)

• 批准号: 10564945
• 负责人: Adam H. de Havenon
• 金额: $ 60.08万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-01 至 2027-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10564945
• 关键词: Acute; Address; Adrenergic beta-Antagonists; Affect; Age; Alteplase; American; Anterior; Antihypertensive Agents; Autonomic nervous system; Blood Pressure; Calcium Channel Blockers; Cessation of life; Circulation; Clinical; Cognition; Data; Dedications; Elements; Enrollment; Ethnic Origin; Fingers; Future; Goals; Growth; Guidelines; Hemorrhage; Home; Hospitalization; Hospitals; Hour; Impaired cognition; Individual; Infarction; Intervention; Intravenous; Ischemic Stroke; Knowledge; Link; MRI Scans; Magnetic Resonance Imaging; Measurement; Measures; Methods; Morbidity - disease rate; Outcome; Patients; Pharmaceutical Preparations; Photoplethysmography; Positioning Attribute; Public Health; Pupil light reflex; Race; Regimen; Research; Site; Stroke; Surrogate Markers; Testing; Therapeutic; United States; United States National Institutes of Health; arm; blood pressure elevation; blood pressure reduction; blood pressure variability; cognitive change; disability; disability risk; endovascular thrombectomy; experience; functional outcomes; health care settings; high risk; mortality; novel; novel strategies; pharmacologic; portability; post stroke; post stroke cognitive impairment; prospective; radiological imaging; sex; standard of care; stroke intervention; stroke outcome; stroke patient; thrombolysis; transmission process

PROJECT SUMMARY/ABSTRACT Stroke affects 800,000 Americans every year and remains a leading cause of long-term disability. Increased blood pressure variability (BPV) has consistently been associated with two to three times higher risk of disability or mortality after acute ischemic stroke (AIS) in retrospective analyses, independent of mean blood pressure. Our central hypothesis is that increased BPV is harmful after AIS and warrants reduction. However, prior BPV research in AIS patients has been retrospective and limited by non-standardized BP measurement and, therefore, BPV is not mentioned in current stroke guidelines. To address the limitations of prior BPV research, determine mechanisms of BPV's deleterious effect, and identify potentially effective methods to reduce BPV, the proposed study will: 1) prospectively validate that “short-term” and “long-term” BPV after AIS onset is associated with functional outcome and define the effect size of different levels of BPV, 2) utilize portable MRI to confirm that final infarct volume, infarct growth and hemorrhagic transformation between baseline (measured within 12 hours of hospital arrival) and 72 hours are mechanistically related to BPV, and 3) utilize bedside pupillometry to determine how the autonomic nervous system contributes to BPV after AIS and evaluate the class effect of antihypertensive medications on BPV. To achieve these goals, we will enroll 150 patients who have anterior circulation stroke and a baseline NIH Stroke Scale ≥6 within 12 hours of AIS onset at three study sites. With completion of the Aims, we will define the outcome for a future trial (disability at 90 days vs. infarct volume or HT vs. post-stroke cognitive impairment at 12 months vs. composites), the effect size of BPV on individual outcomes and composites, the duration for lowering BPV (24-72 hours vs. weeks or months), and potential interventions to reduce BPV. Pharmacologic BPV reduction would be an inexpensive and widely available intervention, able to be administered in a range of healthcare settings. By completing the proposed Aims, we will be ideally positioned to test accessible targeted interventions to diminish the morbidity and mortality of AIS.

项目总结/摘要 中风每年影响80万美国人，仍然是长期残疾的主要原因。增加 血压变异性（BPV）一直与高出2 - 3倍的残疾风险相关 或急性缺血性卒中（AIS）后的死亡率，与平均血压无关。 我们的中心假设是，增加BPV是有害的AIS后，值得减少。然而，之前的BPV 对AIS患者的研究是回顾性的并且受到非标准化BP测量的限制， 因此，在目前的卒中指南中没有提到BPV。为了解决先前BPV研究的局限性， 确定BPV的有害影响的机制，并确定潜在的有效方法，以减少BPV， 拟议的研究将：1）前瞻性验证AIS发作后的“短期”和“长期”BPV是否相关 与功能结局，并确定不同BPV水平的效应量，2）利用便携式MRI确认 最终梗死体积、梗死生长和出血性转化在基线（12分钟内测量）之间， 到达医院的时间）和72小时与BPV机械相关，3）利用床边瞳孔测量， 确定AIS后自主神经系统如何影响BPV，并评估 降压药物BPV。为了实现这些目标，我们将招募150名患有前房 在3个研究中心，AIS发作后12小时内循环卒中和基线NIH卒中量表≥6。与 完成目标后，我们将确定未来试验的结果（90天残疾与梗死体积或HT vs. 12个月时卒中后认知功能障碍与复合终点），BPV对个体结局的效应量 和复合物、降低BPV的持续时间（24-72小时与数周或数月）和潜在干预措施 降低BPV。药理学BPV降低将是一种廉价且广泛可用的干预措施， 在一系列医疗机构中使用。通过完成拟议的目标，我们将理想地 定位于测试可获得的有针对性的干预措施，以减少AIS的发病率和死亡率。