一项国家急性卒中登记研究中急性卒中和短暂性脑缺血发作患者的入院血压趋势及卒中结局
Trends in admission blood pressure and stroke outcome in patients with acute stroke and transient ischemic attack in a National Acute Stroke registry.
作者信息
Koton Silvia, Eizenberg Yoav, Tanne David, Grossman Ehud
机构信息
aSackler Faculty of Medicine, Tel Aviv UniversitybDepartment of Endocrinology, Diabetes and Metabolism, Clalit Health ServicescNeurology Department and Joseph Sagol Neuroscience CenterdInternal Medicine D and Hypertension Unit, the Chaim Sheba Medical Center, Tel Hashomer, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel*Silvia Koton and Yoav Eizenberg are co-first authors to the writing of this article.
出版信息
J Hypertens. 2016 Feb;34(2):316-22. doi: 10.1097/HJH.0000000000000797.
OBJECTIVE
Elevated blood pressure (BP) is common during an acute stroke and is associated with unfavorable outcome. Management of hypertension has improved in recent years. We aimed to evaluate trends in admission BP levels in patients admitted with acute stroke and transient ischemic attack (TIA) over the past decade.
METHODS
Data were based on the National Acute Stroke Israeli Registry. The study population comprised 6177 patients, aged at least 18 years admitted for acute stroke (4382 ischemic stroke and 476 intracerebral hemorrhage) or TIA (1227) and had data on BP levels on admission. We studied temporal trends in admission BP and preadmission antihypertensive therapy from 2004 to 2010.
RESULTS
Admission SBP (mean ± SD) in patients with acute stroke decreased from 161 ± 29 mmHg in 2004 to 153 ± 28 mmHg in 2010 (P < 0.001). Similar trends were observed for patients with TIA. The use of three or more antihypertensive agents before stroke onset increased from 16.9% in 2004 to 20.0% in 2010 (P = 0.02). In patients with acute stroke, higher admission SBP was associated with increased stroke severity (P < 0.001). Rate of disability at discharge or in-hospital death decreased from 71.3% in 2004 to 64.8% in 2010 (P < 0.0001). Admission SBP was associated with disability at discharge or in-hospital death with an adjusted odds ratio (95% confidence interval) of 1.06 (1.04-1.08) per 10 mmHg change in SBP.
CONCLUSION
Admission SBP in patients with acute stroke and TIA decreased from 2004 to 2010 and may have contributed to the improved outcome in these patients.
目的
急性卒中期间血压升高很常见，且与不良预后相关。近年来高血压的管理有所改善。我们旨在评估过去十年中急性卒中和短暂性脑缺血发作（TIA）患者入院时血压水平的变化趋势。
方法
数据基于以色列国家急性卒中登记处。研究人群包括6177名年龄至少18岁的因急性卒中（4382例缺血性卒中和476例脑出血）或TIA（1227例）入院且有入院时血压水平数据的患者。我们研究了2004年至2010年入院血压和入院前抗高血压治疗的时间趋势。
结果
急性卒中患者的入院收缩压（均值±标准差）从2004年的161±29 mmHg降至2010年的153±28 mmHg（P<0.001）。TIA患者也观察到类似趋势。卒中发作前使用三种或更多抗高血压药物的比例从2004年的16.9%增至2010年的20.0%（P=0.02）。在急性卒中患者中，较高的入院收缩压与卒中严重程度增加相关（P<0.001）。出院时残疾率或院内死亡率从2004年的71.3%降至2010年的64.8%（P<0.0001）。入院收缩压与出院时残疾或院内死亡相关，收缩压每变化10 mmHg，调整后的优势比（95%置信区间）为1.06（1.04-1.08）。
结论
2004年至2010年，急性卒中和TIA患者的入院收缩压下降，这可能有助于改善这些患者的预后。
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