Vemmos K N, Tsivgoulis G, Spengos K, Zakopoulos N, Synetos A, Manios E, Konstantopoulou P, Mavrikakis M
Acute Stroke Unit, Department of Clinical Therapeutics, University of Athens, Athens, Greece.
J Intern Med. 2004 Feb;255(2):257-65. doi: 10.1046/j.1365-2796.2003.01291.x.
To evaluate the relationship between systolic blood pressure (SBP) or diastolic blood pressure (DBP) on admission and early or late mortality in patients with acute stroke.
Prospective study of hospitalized first-ever stroke patients over 8 years.
Stroke unit and medical wards in a University hospital.
A total of 1121 patients admitted within 24 h from stroke onset and followed up for 12 months.
Mortality at 1 and 12 months after stroke in relation to admission SBP and DBP.
Early and late mortality in patients with acute ischaemic or haemorrhagic stroke in relation to admission SBP and DBP followed a 'U-curve pattern'. After adjusting for known outcome predictors, the relative risk of 1-month and 1-year mortality associated with a 10-mmHg SBP increase above 130 mmHg (U-point of the curve) increased by 10.2% (95% CI: 4.2-16.6%) and 7.2% (95% CI: 2.2-12.3%), respectively. For every 10 mmHg SBP decrease, below the U-point, the relative risk of 1-month and 1-year mortality rose by 28.2% (95% CI: 8.6-51.3%) and 17.5% (95% CI: 3.1-34.0%), respectively. Low admission SBP-values were associated with heart failure (P < 0.001) and coronary artery disease (P = 0.006), whilst high values were associated with history of hypertension (P < 0.001) and lacunar stroke (P < 0.001). Death due to cerebral oedema was significantly (P = 0.005) more frequent in patients with high admission SBP-values, whereas death due to cardiovascular disease was more frequent (P = 0.004) in patients with low admission SBP-values.
Acute ischaemic or haemorrhagic stroke patients with high and low admission BP-values have a higher early and late mortality. Coincidence of heart disease is associated with low initial BP-values. Death due to neurological damage from brain oedema is associated with high initial BP-values.
评估急性卒中患者入院时的收缩压（SBP）或舒张压（DBP）与早期或晚期死亡率之间的关系。
对首次发生卒中的住院患者进行为期8年的前瞻性研究。
一所大学医院的卒中单元和内科病房。
共有1121例患者在卒中发作后24小时内入院，并随访12个月。
卒中后1个月和12个月的死亡率与入院时SBP和DBP的关系。
急性缺血性或出血性卒中患者的早期和晚期死亡率与入院时SBP和DBP呈“U型曲线模式”。在对已知的预后预测因素进行校正后，SBP高于130 mmHg（曲线的U点）每升高10 mmHg，1个月和1年死亡率的相对风险分别增加10.2%（95%CI：4.2 - 16.6%）和7.2%（95%CI：2.2 - 12.3%）。SBP低于U点每降低10 mmHg，1个月和1年死亡率的相对风险分别升高28.2%（95%CI：8.6 - 51.3%）和17.5%（95%CI：3.1 - 34.0%）。入院时SBP值低与心力衰竭（P < 0.001）和冠状动脉疾病（P = 0.006）相关，而高值与高血压病史（P < 0.001）和腔隙性卒中（P < 0.001）相关。入院时SBP值高的患者因脑水肿导致的死亡显著更频繁（P = 0.005），而入院时SBP值低的患者因心血管疾病导致的死亡更频繁（P = 0.004）。
入院时BP值高和低的急性缺血性或出血性卒中患者早期和晚期死亡率更高。心脏病的并存与初始BP值低相关。因脑水肿导致神经损伤的死亡与初始BP值高相关。
