Hong Yoon-Ho, Lee Yong-Seok, Park Seong-Ho
Department of Neurology, Seoul Municipal Boramae Hospital and College of Medicine, Seoul National University, Seoul, Korea.
Can J Neurol Sci. 2003 Aug;30(3):210-4. doi: 10.1017/s0317167100002602.
Elevation of blood pressure (BP) is common in acute cerebral infarction, with several studies reporting a high plasma catecholamine level or previous hypertension as a contributory factor. However, more comprehensive studies on associated clinical parameters are lacking. Our main aim in undertaking this study was to correlate clinical variables associated with a BP elevation in acute ischemic stroke.
Consecutive patients who were admitted to the emergency room and diagnosed with an acute cerebral infarction within 24 hours after the onset of symptoms were investigated. A BP elevation was defined as a high systolic (> or = 200mmHg) or diastolic (> or = 110 mmHg) pressure. The mean systolic and diastolic BP were compared between the different stroke subtypes, lesion locations (carotid vs. vertebrobasilar), and hemispheric sides. The frequency of symptoms, risk factors, location of the infarct, stroke severity, vascular status and laboratory abnormalities were analyzed in order to build a regression model.
On hundred thirty-one patients were recruited (M:F = 60:71, mean age 66 +/- 12 years) and an elevated BP was identified in 33 patients (25.2%). The mean systolic and diastolic BP did not differ significantly between the stroke subtypes, lesion locations, and hemispheric sides. According to univariate logistic regression, an elevated systolic BP correlated with headache (p = 0.01) and underlying hypertension (p = 0.02) while an elevated diastolic BP correlated with underlying hypertension (p = 0.01). Multivariate logistic regression analysis revealed previous hypertension (OR 5.21, 95% CI 1.40-19.37) and headache (OR 4.09, 95% CI 1.44-11.66) to be independent predictors of an elevated systolic BP.
Headache itself is closely associated with severe systolic BP elevation in acute ischemic stroke. Whether treatment of elevated BP improves headache and clinical outcome is not yet known, necessitating future controlled studies.
血压（BP）升高在急性脑梗死中很常见，多项研究报告血浆儿茶酚胺水平升高或既往高血压是一个促成因素。然而，缺乏对相关临床参数的更全面研究。我们进行这项研究的主要目的是关联急性缺血性卒中中与血压升高相关的临床变量。
对连续入住急诊室且在症状发作后24小时内被诊断为急性脑梗死的患者进行调查。血压升高定义为收缩压高（≥200mmHg）或舒张压高（≥110mmHg）。比较不同卒中亚型、病变部位（颈动脉与椎基底动脉）和半球侧的平均收缩压和舒张压。分析症状频率、危险因素、梗死部位、卒中严重程度、血管状况和实验室异常情况，以建立回归模型。
招募了131名患者（男:女 = 60:71，平均年龄66±12岁），33名患者（25.2%）血压升高。卒中亚型、病变部位和半球侧之间的平均收缩压和舒张压无显著差异。根据单因素逻辑回归分析，收缩压升高与头痛（p = 0.01）和基础高血压（p = 0.02）相关，而舒张压升高与基础高血压（p = 0.01）相关。多因素逻辑回归分析显示，既往高血压（OR 5.21，95%CI 1.40 - 19.37）和头痛（OR 4.09，95%CI 1.44 - 11.66）是收缩压升高的独立预测因素。
头痛本身与急性缺血性卒中严重的收缩压升高密切相关。血压升高的治疗是否能改善头痛和临床结局尚不清楚，需要未来进行对照研究。
