Barton Christopher W, Hemphill J Claude
Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Acad Emerg Med. 2007 Aug;14(8):695-701. doi: 10.1197/j.aem.2007.03.1358.
Hypertension is common after intracranial hemorrhage (ICH) and may be associated with higher mortality and adverse neurologic outcome. The American Heart Association recommends that blood pressure be maintained at a mean arterial pressure (MAP) less than 130 mm Hg to prevent secondary brain injury.
To prospectively evaluate whether a new method of assessing hypertension in ICH more accurately identifies patients at risk for adverse outcomes.
The authors prospectively studied all patients presenting to two University of California, San Francisco hospitals with acute ICH from June 1, 2001, to May 31, 2004. Factors related to acute hospitalization were recorded in a database, including all charted vital signs for the first 15 days. Patients were followed up for one year, with their modified Rankin Scale (mRS) score at 12 months as primary outcome. Hypertension dose was determined as the area under the curve between patient MAP and a cut point of 110 mm Hg while in the emergency department (ED). The dose was adjusted for time spent in the ED (dose/time(ed) [d/t(ed)]). Hypertension dose was divided into four categories (none, and progressive tertiles). Multivariate logistic regression was used to calculate the odds ratio for adverse mRS by tertiles of d/t(ed).
A total of 237 subjects with an ED average (+/-SD) length of stay of 3.42 (+/-3.7) hours were enrolled. In a multivariate logistic regression model controlling for the effects of age, volume of hemorrhage, presence of intraventricular hemorrhage, race, and preexisting hypertension, there was a 4.7- and 6.1-fold greater likelihood of an adverse neurologic outcome (by mRS) at one and 12 months, respectively, in the highest d/t(ed) tertile relative to the referent group without hypertension.
Hypertension after acute ICH is associated with adverse neurologic outcome. The dose of hypertension may more accurately identify patients at risk for adverse outcomes than the American Heart Association guidelines and may lead to better outcomes if treated when identified in this manner.
颅内出血（ICH）后高血压很常见，可能与较高的死亡率和不良神经功能结局相关。美国心脏协会建议将平均动脉压（MAP）维持在130 mmHg以下，以预防继发性脑损伤。
前瞻性评估一种评估ICH患者高血压的新方法是否能更准确地识别有不良结局风险的患者。
作者前瞻性研究了2001年6月1日至2004年5月31日期间在加利福尼亚大学旧金山分校的两家医院就诊的所有急性ICH患者。与急性住院相关的因素记录在数据库中，包括前15天所有记录的生命体征。对患者进行一年的随访，将12个月时的改良Rankin量表（mRS）评分作为主要结局。高血压剂量被确定为患者在急诊科（ED）时MAP与110 mmHg切点之间的曲线下面积。该剂量根据在ED花费的时间进行调整（剂量/时间（ed）[d/t（ed）]）。高血压剂量分为四类（无、低、中、高）。多因素逻辑回归用于计算按d/t（ed）三分位数划分的不良mRS的比值比。
共纳入237名受试者，其在ED的平均（±标准差）住院时间为3.42（±3.7）小时。在一个控制了年龄、出血量、脑室内出血、种族和既往高血压影响的多因素逻辑回归模型中，相对于无高血压的参照组，最高d/t（ed）三分位数组在1个月和12个月时出现不良神经功能结局（根据mRS）的可能性分别高出4.7倍和6.1倍。
急性ICH后高血压与不良神经功能结局相关。与美国心脏协会指南相比，高血压剂量可能更准确地识别有不良结局风险的患者，如果以这种方式识别并进行治疗，可能会带来更好的结局。
