From the Department of Cerebrovascular Medicine (E.T., J.K., T.O., S.S., K.M., K.T.), Division of Stroke Care Unit (M.K., S.A.), and Department of Neurology (H.Y, K.N.), National Cerebral and Cardiovascular Center, Suita, Japan; Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan (K. Kario); Department of Neurosurgery and Stroke Center, Nakamura Memorial Hospital, Sapporo, Japan (K. Kamiyama); Department of Stroke Neurology, Kohnan Hospital, Sendai, Japan (E.F.); Department of Neurosurgery and Stroke Center, Kyorin University School of Medicine, Mitaka, Japan (Y.S.); Department of Neurology, St Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurology, NHO Nagoya Medical Center, Nagoya, Japan (S.O.); Department of Neurology, Stroke Center, Kobe City Medical Center General Hospital, Kobe, Japan (H.Y.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (K. Kimura); and Department of Cerebrovascular Medicine, NHO Kyushu Medical Center, Fukuoka, Japan (Y.O.).
Stroke. 2014 Aug;45(8):2275-9. doi: 10.1161/STROKEAHA.114.005420. Epub 2014 Jun 26.
The associations between early blood pressure (BP) variability and clinical outcomes in patients with intracerebral hemorrhage after antihypertensive therapy, recently clarified by a post hoc analysis of Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial 2 (INTERACT2), were confirmed using the Stroke Acute Management with Urgent Risk-factor Assessment and Improvement (SAMURAI)-intracerebral hemorrhage study cohort.
Patients with hyperacute (<3 hours from onset) intracerebral hemorrhage with initial systolic BP (SBP) >180 mm Hg were registered in a prospective, multicenter, observational study. All patients received antihypertensive therapy based on a predefined standardized protocol to lower and maintain SBP between 120 and 160 mm Hg using intravenous nicardipine. BPs were measured hourly during the initial 24 hours. BP variability was determined as SD and successive variation. The associations between BP variability and hematoma expansion (>33%), neurological deterioration within 72 hours, and unfavorable outcome (modified Rankin Scale, 4-6) at 3 months were assessed.
Of the 205 patients, 33 (16%) showed hematoma expansion, 14 (7%) showed neurological deterioration, and 81 (39%) had unfavorable outcomes. The SD and successive variation of SBP were 13.8 (interquartile range, 11.5-16.8) and 14.9 (11.7-17.7) mm Hg, respectively, and those of diastolic BP were 9.4 (7.5-11.2) and 13.1 (11.2-15.9) mm Hg, respectively. On multivariate regression analyses, neurological deterioration was associated with the SD of SBP (odds ratio, 2.75; 95% confidence interval, 1.45-6.12 per quartile) and the successive variation of SBP (2.37; 1.32-4.83), and unfavorable outcome was associated with successive variation of SBP (1.42; 1.04-1.97). Hematoma expansion was not associated with any BP variability.
SBP variability during the initial 24 hours of acute intracerebral hemorrhage was independently associated with neurological deterioration and unfavorable outcomes. Stability of antihypertensive therapy may improve clinical outcomes.
强化降压急性脑出血试验 2 （INTERACT2）的事后分析最近明确了降压治疗后颅内出血患者早期血压（BP）变异性与临床结局之间的关系，本研究使用急性卒中管理中紧急风险因素评估和改善（SAMURAI）-颅内出血研究队列进行了证实。
本前瞻性、多中心、观察性研究注册了发病时间<3 小时、初始收缩压（SBP）>180mmHg 的超急性期（hyperacute）颅内出血患者。所有患者均接受了降压治疗，根据预设的标准化方案，使用静脉注射尼卡地平将 SBP 降低并维持在 120-160mmHg 之间。在最初的 24 小时内，每小时测量一次血压。BP 变异性用标准差（SD）和连续变化来确定。评估了 BP 变异性与血肿扩大（>33%）、72 小时内神经功能恶化以及 3 个月时不良结局（改良 Rankin 量表，4-6 分）之间的关系。
205 例患者中，33 例（16%）发生血肿扩大，14 例（7%）发生神经功能恶化，81 例（39%）结局不良。SBP 的 SD 和连续变化分别为 13.8（四分位距，11.5-16.8）和 14.9（11.7-17.7）mmHg，舒张压的 SD 和连续变化分别为 9.4（7.5-11.2）和 13.1（11.2-15.9）mmHg。多变量回归分析显示，神经功能恶化与 SBP 的 SD（优势比，2.75；95%置信区间，每四分位数 1.45-6.12）和 SBP 的连续变化（2.37；1.32-4.83）相关，不良结局与 SBP 的连续变化相关（1.42；1.04-1.97）。血肿扩大与任何 BP 变异性均无关。
急性颅内出血最初 24 小时内的 SBP 变异性与神经功能恶化和不良结局独立相关。降压治疗的稳定性可能改善临床结局。
