Vemmos K N, Spengos K, Tsivgoulis G, Zakopoulos N, Manios E, Kotsis V, Daffertshofer M, Vassilopoulos D
Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, Athens, Greece.
J Hum Hypertens. 2004 Apr;18(4):253-9. doi: 10.1038/sj.jhh.1001662.
The aim of this prospective observational study was to determine the association of acute blood pressure values with independent factors (demographic, clinical characteristics, early complications) in stroke subgroups of different aetiology. We evaluated data of 346 first-ever acute (<24 h) stroke patients treated in our stroke unit. Casual and 24-h blood pressure (BP) values were measured. Stroke risk factors and stroke severity on admission were documented. Strokes were divided into subgroups of different aetiopathogenic mechanism. Patients were imaged with CT-scan on admission and 5 days later to determine the presence of brain oedema and haemorrhagic transformation. The relationship of different factors to 24-h BP values (24-h BP) was evaluated separately in each stroke subgroup. In large artery atherosclerotic stroke (n=59), history of hypertension and stroke severity correlated with higher 24-h BP respectively. In cardioembolic stroke (n=87), history of hypertension, stroke severity, haemorrhagic transformation and brain oedema were associated with higher 24-h BP, while heart failure with lower 24-h BP. History of hypertension and coronary artery disease was related to higher and lower 24-h BP, respectively, in lacunar stroke (n=75). In patients with infarct of undetermined (n=57) cause 24-h BP were mainly influenced by stroke severity and history of hypertension. An independent association between higher 24-h BP and history of hypertension and cerebral oedema was documented in intracerebral haemorrhage (n=68). In conclusion, different factors influence acute BP values in stroke subtypes of different aetiology. If the clinical significance of these observations is verified, a differentiated approach in acute BP management based on stroke aetiology may be considered.
这项前瞻性观察性研究的目的是确定不同病因的卒中亚组中急性血压值与独立因素（人口统计学、临床特征、早期并发症）之间的关联。我们评估了在我们卒中单元接受治疗的346例首次急性（<24小时）卒中患者的数据。测量了随机和24小时血压（BP）值。记录了入院时的卒中危险因素和卒中严重程度。卒中被分为不同病因发病机制的亚组。患者在入院时和5天后进行CT扫描成像，以确定脑水肿和出血转化的存在。在每个卒中亚组中分别评估不同因素与24小时血压值（24-h BP）之间的关系。在大动脉粥样硬化性卒中（n=59）中，高血压病史和卒中严重程度分别与较高的24小时血压相关。在心源性栓塞性卒中（n=87）中，高血压病史、卒中严重程度、出血转化和脑水肿与较高的24小时血压相关，而心力衰竭与较低的24小时血压相关。在腔隙性卒中（n=75）中，高血压病史和冠状动脉疾病分别与较高和较低的24小时血压相关。在病因不明的梗死患者（n=57）中，24小时血压主要受卒中严重程度和高血压病史的影响。在脑出血（n=68）中，记录到较高的24小时血压与高血压病史和脑水肿之间存在独立关联。总之,不同因素影响不同病因的卒中亚型的急性血压值。如果这些观察结果的临床意义得到证实,则可考虑根据卒中病因在急性血压管理中采取差异化方法。
