Manning Lisa S, Mistri Amit K, Potter John, Rothwell Peter M, Robinson Thompson G
From the Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (L.S.M., A.K.M., T.G.R.); Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, United Kingdom (J.P.); and Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom (P.M.R.).
Stroke. 2015 Jun;46(6):1518-24. doi: 10.1161/STROKEAHA.115.009078. Epub 2015 Apr 23.
Short-term blood pressure variability (BPV) may predict outcome in acute stroke. We undertook a post hoc analysis of data from 2 randomized controlled trials to determine the effect of short-term BPV on 2-week outcome.
Controlling Hypertension and Hypotension Immediately Post Stroke (CHHIPS) was a trial of BP-lowering, enrolling 179 acute stroke patients (onset<36 hours). Continue or Stop Post-Stroke Antihypertensives Collaborative Study (COSSACS) compared a strategy of continuation versus temporarily stopping prestroke antihypertensive therapy in 763 acute stroke patients (onset<48 hours). BPV at baseline (defined as SD, coefficient of variation, variation independent of the mean, and average real variability) was derived from standardized casual cuff BP measures (6 readings<30 minutes). Adjusted logistic regression models were used to assess the relation between BPV and death and disability (modified Rankin scale>3) at 2 weeks.
Seven hundred six (92.5%) and 171 (95.5%) participants were included in the analysis for the COSSACS and CHHIPS data sets, respectively. Adjusted logistic regression analyses revealed no statistically significant associations between any of the included BPV parameters with 2-week death or disability in either study data set: COSSACS, odds ratio SD systolic BP 0.98 (0.78-1.23); CHHIPS, odds ratio SD systolic BP 0.97 (0.90-1.11).
When derived from casual cuff BP measures, short-term BPV is not a useful predictor of early (2 weeks) outcome after acute stroke. Differing methodology may account for the discordance with previous studies indicating long-term (casual BPV) and short-term (beat-to-beat BPV) prognostic value.
COSSACS was registered on the International Standard Randomised Controlled Trial Register; URL: http://www.isrctn.com. Unique identifier: ISRCTN89712435. CHHIPS was registered on the National Research Register; URL: http://public.ukcrn.org.uk. Unique identifier: N0484128008.
短期血压变异性（BPV）可能预测急性卒中的预后。我们对两项随机对照试验的数据进行了事后分析，以确定短期BPV对2周预后的影响。
卒中后立即控制高血压和低血压（CHHIPS）试验是一项降压试验，纳入179例急性卒中患者（发病时间<36小时）。继续或停用卒中后抗高血压药物协作研究（COSSACS）比较了763例急性卒中患者（发病时间<48小时）继续或暂时停用卒中前抗高血压治疗策略。基线时的BPV（定义为标准差、变异系数、与均值无关的变异以及平均实际变异性）来自标准化的偶测袖带血压测量值（30分钟内6次读数）。采用校正逻辑回归模型评估BPV与2周时死亡和残疾（改良Rankin量表>3）之间的关系。
分别有706例（92.5%）和171例（95.5%）参与者纳入COSSACS和CHHIPS数据集的分析。校正逻辑回归分析显示，在任何一项研究数据集中，所纳入的BPV参数与2周时的死亡或残疾之间均无统计学显著关联：COSSACS，收缩压标准差的比值比为0.98（0.78 - 1.23）；CHHIPS，收缩压标准差的比值比为0.97（0.90 - 1.11）。
从偶测袖带血压测量值得出的短期BPV并非急性卒中后早期（2周）预后的有用预测指标。不同的方法学可能解释了与先前表明长期（偶测BPV）和短期（逐搏BPV）预后价值的研究结果不一致的原因。
COSSACS在国际标准随机对照试验注册库注册；网址：http://www.isrctn.com。唯一标识符：ISRCTN89712435。CHHIPS在国家研究注册库注册；网址：http://public.ukcrn.org.uk。唯一标识符：N0484128008。
