From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (K.F., J.H., T.A., T.K.), Department of Health Care Administration and Management, Graduate School of Medical Sciences (M.K.), and Center for Cohort Studies, Graduate School of Medical Sciences (M.K., J.H., T.K.), Kyushu University, Fukuoka, Japan; Department of Cerebrovascular Disease, St. Mary's Hospital, Kurume, Japan (K.F.); Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Kurume, Japan (K.F., H.K., T.I.); Cerebrovascular and Neurology Center, National Hospital Organization Fukuoka-Higashi Medical Center, Koga, Japan (H.N.); and International University of Health and Welfare, Fukuoka Sannou Hospital, Fukuoka, Japan (T.I.).
Stroke. 2015 Jul;46(7):1832-9. doi: 10.1161/STROKEAHA.115.009076. Epub 2015 Jun 11.
The relationship between blood pressure (BP) variability and functional outcome in patients with acute ischemic stroke remains unclear. This study aimed to elucidate whether in-hospital day-by-day BP variability is associated with functional outcome after acute ischemic stroke.
Using the Fukuoka Stroke Registry, we included 2566 patients with a first-ever ischemic stroke who had been functionally independent before the onset and were hospitalized within 24 hours. BP was measured daily, and its variability was assessed by SD, coefficients of variance, and variations independent of mean. Poor functional outcome was assessed by modified Rankin Scale scores ≥3 at 3 months.
After adjustment for multiple confounding factors including age, sex, risk factors, stroke features, baseline severity, thrombolytic therapy, antihypertensive agents, and mean BP, day-by-day BP variability during the subacute stage (4-10 days after onset) was independently associated with a poor functional outcome (multivariable-adjusted odds ratios [95% confidence interval] in the top versus bottom quartile of systolic BP variability, 1.51 [1.09-2.08] for SD; 1.63 [1.20-2.22] for coefficients of variance; 1.64 [1.21-2.24] for variations independent of mean). Similar trends were also observed for diastolic BP variability. These trends were unchanged in patients who were not treated with antihypertensive drugs. In contrast, no association was found between indices of BP variability during the acute stage and functional outcome after adjusting for potential confounders.
These data suggest that intraindividual day-by-day BP variability during the subacute stage is associated with the 3-month functional outcome after acute ischemic stroke.
血压（BP）变异性与急性缺血性脑卒中患者功能结局之间的关系尚不清楚。本研究旨在阐明急性缺血性脑卒中患者住院期间的日间 BP 变异性是否与功能结局相关。
利用福冈卒中登记研究，我们纳入了 2566 例首发且发病前功能独立、发病 24 小时内入院的首次缺血性卒中患者。每天测量血压，通过标准差、变异系数和均值无关变异来评估其变异性。采用改良 Rankin 量表评分≥3 分评估 3 个月时的功能结局。
在校正了年龄、性别、危险因素、卒中特征、基线严重程度、溶栓治疗、降压药物和平均 BP 等多个混杂因素后，亚急性期（发病后 4-10 天）的日间 BP 变异性与不良功能结局独立相关（最高四分位与最低四分位的收缩压变异性的多变量校正比值比[95%置信区间]，1.51[1.09-2.08]；变异系数为 1.63[1.20-2.22]；均值无关变异为 1.64[1.21-2.24]）。舒张压变异性也存在类似趋势。在未接受降压药物治疗的患者中，这些趋势保持不变。相反，在校正潜在混杂因素后，急性阶段的 BP 变异性指标与功能结局之间无关联。
这些数据表明，亚急性期内个体日间 BP 变异性与急性缺血性脑卒中后 3 个月的功能结局相关。
