Sprigg Nikola, Gray Laura J, Bath Philip M W, Boysen Gudrun, De Deyn Peter Paul, Friis Pal, Leys Didier, Marttila Reijo, Olsson Jan-Edwin, O'Neill Desmond, Ringelstein Bernd, van der Sande Jan-Jacob, Lindenstrøm Ewa
Institute of Neuroscience, University of Nottingham, Nottingham, UK.
J Hypertens. 2006 Jul;24(7):1413-7. doi: 10.1097/01.hjh.0000234123.55895.12.
A poor outcome after stroke is associated independently with high blood pressure during the acute phase; however, relationships with other haemodynamic measures [heart rate (HR), pulse pressure (PP), rate-pressure product (RPP)] remain less clear.
The Tinzaparin in Acute Ischaemic Stroke Trial is a randomised, controlled trial assessing the safety and efficacy of tinzaparin versus aspirin in 1484 patients with acute ischaemic stroke. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and HR measurements taken immediately prior to randomization were averaged, and the mid-blood pressure (MBP), PP, mean arterial pressure (MAP), pulse pressure index, and RPP were calculated. The relationship between these haemodynamic measures and functional outcome (death or dependency, modified Rankin Scale > 2) and early recurrent stroke, were studied with adjustment for baseline prognostic factors and treatment group. Odds ratios (OR) and 95% confidence intervals (CI) refer to a change in haemodynamic measure by 10 points.
A poor functional outcome was associated with SBP (adjusted OR; 1.11; 95% CI, 1.03-1.21), HR (adjusted OR; 1.15; 95% CI, 1.00-1.31), MBP (adjusted OR; 1.15, 95% CI, 1.03-1.29), PP (adjusted OR; 1.14; 95% CI, 1.02-1.26), MAP (adjusted OR; 1.15; 95% CI, 1.02-1.31) and RPP (adjusted OR; 1.01; 95% CI, 1.00-1.02). Early recurrent stroke was associated with SBP, DBP, MBP and MAP.
A poor outcome is independently associated with elevations in blood pressure, HR and their derived haemodynamic variables, including PP and the RPP. Agents that modify these measures may improve functional outcome after stroke.
卒中后不良预后与急性期高血压独立相关；然而，与其他血流动力学指标[心率（HR）、脉压（PP）、率压乘积（RPP）]的关系仍不太明确。
替扎肝素治疗急性缺血性卒中试验是一项随机对照试验，评估替扎肝素与阿司匹林对1484例急性缺血性卒中患者的安全性和有效性。将随机分组前即刻测得的收缩压（SBP）、舒张压（DBP）和心率测量值进行平均，并计算平均血压（MBP）、PP、平均动脉压（MAP）、脉压指数和RPP。在对基线预后因素和治疗组进行校正后，研究这些血流动力学指标与功能结局（死亡或依赖，改良Rankin量表评分>2）和早期复发性卒中之间的关系。比值比（OR）和95%置信区间（CI）指血流动力学指标变化10个单位。
不良功能结局与SBP（校正OR；1.11；95%CI，1.03 - 1.21）、HR（校正OR；1.15；95%CI，1.00 - 1.31）、MBP（校正OR；1.15，95%CI，1.03 - 1.29）、PP（校正OR；1.14；95%CI，1.02 - 1.26）、MAP（校正OR；1.15；95%CI，1.02 - 1.31）和RPP（校正OR；1.01；95%CI，1.00 - 1.02）相关。早期复发性卒中与SBP、DBP、MBP和MAP相关。
不良结局与血压、心率及其衍生的血流动力学变量（包括PP和RPP）升高独立相关。调节这些指标的药物可能改善卒中后的功能结局。
