Skalidi Sophia J, Manios Efstathios D, Stamatelopoulos Kimon S, Barlas Gerasimos, Michas Fotios, Toumanidis Savvas T, Vemmos Konstantinos N, Zakopoulos Nikolaos A
Department of Clinical Therapeutics, Medical School of Athens, Alexandra Hospital, Athens, Greece.
Blood Press Monit. 2013 Aug;18(4):203-7. doi: 10.1097/MBP.0b013e3283631b28.
Both brain edema and increased blood pressure (BP) variability are associated with poor outcome after stroke. The aim of the present study was to evaluate a possible association between edema formation and a relatively new index of BP variability defined as time rate (TR) of BP variation.
A total of 128 first-ever acute stroke patients underwent 24-h ambulatory BP monitoring within 24 h from onset of stroke. All patients were imaged with computed tomography scan on admission and after 5 days to determine the presence of brain edema. The TR of BP variation was defined as the first derivative of the BP values against time. Known risk factors and neurological severity on admission were documented.
The 24-h TR of systolic BP variation was significantly higher (P<0.001) in stroke patients with brain edema (0.69±0.15 mmHg/min) compared with those without edema (0.57±0.12 mmHg/min). The multivariate logistic regression model showed that a 0.1 mmHg/min increase in the TR of 24-h systolic BP variation was associated with a 13.9% increased probability of the presence of brain edema (odds ratio=1.139, 95% confidence interval: 1.058-1.225, P<0.001), after adjusting for history of diabetes mellitus, hypercholesterolemia, type of stroke, neurological deficit, and 24-h systolic BP.
Increased values of 24-h TR of systolic BP variation are associated independently with formation of edema in acute stroke patients.
脑水肿和血压（BP）变异性增加均与卒中后不良预后相关。本研究的目的是评估水肿形成与一种相对较新的血压变异性指标（定义为血压变化的时间速率（TR））之间可能存在的关联。
共有128例首次发生急性卒中的患者在卒中发作后24小时内接受了24小时动态血压监测。所有患者在入院时和5天后均进行了计算机断层扫描成像，以确定是否存在脑水肿。血压变化的TR定义为血压值相对于时间的一阶导数。记录已知的危险因素和入院时的神经功能严重程度。
与无水肿的卒中患者（0.57±0.12 mmHg/分钟）相比，有脑水肿的卒中患者收缩压变化的24小时TR显著更高（P<0.001）（0.69±0.15 mmHg/分钟）。多因素逻辑回归模型显示，在调整了糖尿病史、高胆固醇血症、卒中类型、神经功能缺损和24小时收缩压后，24小时收缩压变化的TR每增加0.1 mmHg/分钟，出现脑水肿的概率增加13.9%（比值比=1.139，95%置信区间：1.058 - 1.225，P<0.001）。
急性卒中患者24小时收缩压变化的TR值升高与水肿形成独立相关。
