Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK.
The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.
Lancet Neurol. 2014 Apr;13(4):364-73. doi: 10.1016/S1474-4422(14)70018-3. Epub 2014 Feb 13.
High blood pressure is a prognostic factor for acute stroke, but blood pressure variability might also independently predict outcome. We assessed the prognostic value of blood pressure variability in participants of INTERACT2, an open-label randomised controlled trial (ClinicalTrials.gov number NCT00716079).
INTERACT2 enrolled 2839 adults with spontaneous intracerebral haemorrhage (ICH) and high systolic blood pressure (150-220 mm Hg) without a definite indication or contraindication to early intensive treatment to reduce blood pressure. Participants were randomly assigned to intensive treatment (target systolic blood pressure <140 mm Hg within 1 h using locally available intravenous drugs) or guideline-recommended treatment (target systolic blood pressure <180 mm Hg) within 6 h of onset of ICH. The primary outcome was death or major disability at 90 days (modified Rankin Scale score ≥3) and the secondary outcome was an ordinal shift in modified Rankin Scale scores at 90 days, assessed by investigators masked to treatment allocation. Blood pressure variability was defined according to standard criteria: five measurements were taken in the first 24 h (hyperacute phase) and 12 over days 2-7 (acute phase). We estimated associations between blood pressure variability and outcomes with logistic and proportional odds regression models. The key parameter for blood pressure variability was standard deviation (SD) of systolic blood pressure, categorised into quintiles.
We studied 2645 (93·2%) participants in the hyperacute phase and 2347 (82·7%) in the acute phase. In both treatment cohorts combined, SD of systolic blood pressure had a significant linear association with the primary outcome for both the hyperacute phase (highest quintile adjusted OR 1·41, 95% CI 1·05-1·90; ptrend=0·0167) and the acute phase (highest quintile adjusted OR 1·57, 95% CI 1·14-2·17; ptrend=0·0124). The strongest predictors of outcome were maximum systolic blood pressure in the hyperacute phase and SD of systolic blood pressure in the acute phase. Associations were similar for the secondary outcome (for the hyperacute phase, highest quintile adjusted OR 1·43, 95% CI 1·14-1·80; ptrend=0·0014; for the acute phase OR 1·46, 95% CI 1·13-1·88; ptrend=0·0044).
Systolic blood pressure variability seems to predict a poor outcome in patients with acute intracerebral haemorrhage. The benefits of early treatment to reduce systolic blood pressure to 140 mm Hg might be enhanced by smooth and sustained control, and particularly by avoiding peaks in systolic blood pressure.
National Health and Medical Research Council of Australia.
高血压是急性中风的预后因素，但血压变异性也可能独立预测预后。我们评估了 INTERACT2 参与者的血压变异性的预后价值，INTERACT2 是一项开放标签随机对照试验（ClinicalTrials.gov 编号：NCT00716079）。
INTERACT2 纳入了 2839 名自发性脑出血（ICH）且收缩压高（150-220mmHg）且无早期强化降压治疗明确适应证或禁忌证的成年人。参与者随机分配接受强化治疗（目标收缩压在 ICH 发病后 1 小时内降至<140mmHg，使用当地可用的静脉药物）或指南推荐的治疗（目标收缩压<180mmHg）。主要结局为 90 天时的死亡或主要残疾（改良 Rankin 量表评分≥3），次要结局为 90 天时改良 Rankin 量表评分的有序变化，由对治疗分配不知情的研究者评估。血压变异性根据标准标准定义：在超急性期（第 1 天至第 2 天）进行 5 次测量，在急性期（第 2 天至第 7 天）进行 12 次测量。我们使用逻辑和比例优势回归模型来估计血压变异性与结局之间的关联。血压变异性的关键参数是收缩压的标准差（SD），分为五组。
我们研究了超急性期的 2645 名（93.2%）参与者和急性期的 2347 名（82.7%）参与者。在两个治疗队列中，收缩压的 SD 与主要结局均有显著的线性关联，在超急性期（最高五分位组调整后的 OR 为 1.41，95%CI 为 1.05-1.90；ptrend=0.0167）和急性期（最高五分位组调整后的 OR 为 1.57，95%CI 为 1.14-2.17；ptrend=0.0124）。对结局最强的预测因素是超急性期的最大收缩压和急性期的收缩压 SD。次要结局的相关性相似（超急性期最高五分位组调整后的 OR 为 1.43，95%CI 为 1.14-1.80；ptrend=0.0014；急性期 OR 为 1.46，95%CI 为 1.13-1.88；ptrend=0.0044）。
收缩压变异性似乎可以预测急性脑出血患者的不良预后。将收缩压降低至 140mmHg 的早期降压治疗的益处可能通过平稳和持续的控制得到增强，特别是通过避免收缩压峰值。
澳大利亚国家卫生与医学研究委员会。
