Department of Medicine, University of Thessaly, Larissa, Greece.
Neurology. 2012 Oct 2;79(14):1440-8. doi: 10.1212/WNL.0b013e31826d5ed6. Epub 2012 Sep 19.
Previous research suggested that proper blood pressure (BP) management in acute stroke may need to take into account the underlying etiology.
All patients with acute ischemic stroke registered in the ASTRAL registry between 2003 and 2009 were analyzed. Unfavorable outcome was defined as modified Rankin Scale score >2. A local polynomial surface algorithm was used to assess the effect of baseline and 24- to 48-hour systolic BP (SBP) and mean arterial pressure (MAP) on outcome in patients with lacunar, atherosclerotic, and cardioembolic stroke.
A total of 791 patients were included in the analysis. For lacunar and atherosclerotic strokes, there was no difference in the predicted probability of unfavorable outcome between patients with an admission BP of <140 mm Hg, 140-160 mm Hg, or >160 mm Hg (15.3 vs 12.1% vs 20.8%, respectively, for lacunar, p = 015; 41.0% vs 41.5% vs 45.5%, respectively, for atherosclerotic, p = 075), or between patients with BP increase vs decrease at 24-48 hours (18.7% vs 18.0%, respectively, for lacunar, p = 0.84; 43.4% vs 43.6%, respectively, for atherosclerotic, p = 0.88). For cardioembolic strokes, increase of BP at 24-48 hours was associated with higher probability of unfavorable outcome compared to BP reduction (53.4% vs 42.2%, respectively, p = 0.037). Also, the predicted probability of unfavorable outcome was significantly different between patients with an admission BP of <140 mm Hg, 140-160 mm Hg, and >160 mm Hg (34.8% vs 42.3% vs 52.4%, respectively, p < 0.01).
This study provides evidence to support that BP management in acute stroke may have to be tailored with respect to the underlying etiopathogenetic mechanism.
既往研究提示急性脑卒中患者的血压（BP）管理可能需要考虑潜在病因。
分析 2003 年至 2009 年 ASTRAL 登记处所有急性缺血性脑卒中患者。预后不良定义为改良 Rankin 量表评分＞2 分。采用局部多项式曲面算法评估基底和 24-48 小时收缩压（SBP）和平均动脉压（MAP）对腔隙性、动脉粥样硬化性和心源性栓塞性脑卒中患者结局的影响。
共纳入 791 例患者。对于腔隙性和动脉粥样硬化性脑卒中，入院 BP＜140mmHg、140-160mmHg 和＞160mmHg 的患者预后不良的预测概率无差异（腔隙性脑卒中分别为 15.3%、12.1%和 20.8%，p=0.15；动脉粥样硬化性脑卒中分别为 41.0%、41.5%和 45.5%，p=0.75），BP 在 24-48 小时升高或降低的患者也无差异（腔隙性脑卒中分别为 18.7%、18.0%，p=0.84；动脉粥样硬化性脑卒中分别为 43.4%、43.6%，p=0.88）。心源性栓塞性脑卒中患者 24-48 小时 BP 升高与预后不良的概率更高相关，与 BP 降低相比（分别为 53.4%和 42.2%，p=0.037）。而且，入院 BP＜140mmHg、140-160mmHg 和＞160mmHg 的患者预后不良的预测概率也有显著差异（分别为 34.8%、42.3%和 52.4%，p＜0.01）。
本研究为急性脑卒中患者的血压管理可能需要根据潜在的病因发病机制进行个体化治疗提供了证据。
