Sare Gillian M, Bath Philip M W, Gray Laura J, Moulin Thierry, Woimant France, England Timothy, Geeganage Chamila, Christensen Hanne, De Deyn Peter Paul, Leys Didier, O'Neill Desmond, Ringelstein E Bernd
Stroke Trials Unit, University of Nottingham, Clinical Sciences Building, City Hospital campus, Nottingham NG7 2UH UK.
Stroke. 2009 Jan;40(1):41-6. doi: 10.1161/STROKEAHA.108.526665. Epub 2008 Nov 6.
High blood pressure (BP) is present in approximately 80% of patients with acute ischemic stroke and is independently associated with poor outcome. There are few data examining the relationship between admission BP and acute CT findings.
TAIST was a randomized controlled trial assessing 10 days of treatment with tinzaparin versus aspirin in 1489 patients with acute ischemic stroke (<48 hr) with admission BP of </=220/120 mmHg. CT brain scans were performed before randomization and after 10 days. The relationships between baseline BP and adjudicated CT findings were assessed. Odds ratios per 10 mmHg change in BP were calculated.
Higher systolic BP (SBP) was associated with abnormal CT scans because of independent associations with chronic changes of leukoariosis (OR, 1.12; 95% CI, 1.05-1.17) and old infarction (OR, 1.12; 95% CI, 1.06-1.17) at baseline, and signs of visible infarction at day 10 (OR, 1.06; 95% CI, 1.00-1.13). A lower SBP was associated with signs of acute infarction (OR, 0.94; 95% CI, 0.89-0.99). Hemorrhagic transformation, dense middle cerebral artery sign, mass effect, and cerebral edema at day 10 were not independently associated with baseline BP.
Although high baseline BP is independently associated with a poor outcome after stroke, this was not shown to be through an association with increased hemorrhagic transformation, cerebral edema, or mass effect; trial design may be suboptimal to detect this. Higher SBP is associated with visible infarction on day 10 scans. The influence of changing BP in acute stroke on CT findings is still to be ascertained.
约80%的急性缺血性卒中患者存在高血压，且高血压与不良预后独立相关。关于入院血压与急性CT表现之间关系的数据较少。
TAIST是一项随机对照试验，在1489例急性缺血性卒中（<48小时）且入院血压≤220/120 mmHg的患者中，评估替奈肝素与阿司匹林治疗10天的效果。在随机分组前和10天后进行头颅CT扫描。评估基线血压与判定的CT表现之间的关系。计算血压每变化10 mmHg的比值比。
较高的收缩压（SBP）与CT扫描异常相关，这是因为在基线时SBP与白质疏松症的慢性改变（比值比，1.12；95%可信区间，1.05 - 1.17）和陈旧性梗死（比值比，1.12；95%可信区间，1.06 - 1.17）独立相关，且与第10天可见梗死的征象相关（比值比，1.06；95%可信区间，1.00 - 1.13）。较低的SBP与急性梗死的征象相关（比值比，0.94；95%可信区间，0.89 - 0.99）。第10天的出血转化、大脑中动脉高密度征、占位效应和脑水肿与基线血压无独立相关性。
尽管高基线血压与卒中后不良预后独立相关，但这并非通过与出血转化增加、脑水肿或占位效应相关来体现；试验设计可能不足以检测到这一点。较高的SBP与第10天扫描时可见的梗死相关。急性卒中时血压变化对CT表现的影响仍有待确定。
