血压与缺血性脑卒中患者的院内转归。
Blood pressure and in-hospital outcomes in patients presenting with ischaemic stroke.
机构信息
Cardiovascular Outcomes Group, The Leon H. Charney Division of Cardiology, Cardiovascular Clinical Research Center, New York University School of Medicine, 530 First Avenue, New York, NY 10016, USA.
Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
出版信息
Eur Heart J. 2017 Oct 1;38(37):2827-2835. doi: 10.1093/eurheartj/ehx330.
AIMS
Post-stroke hypertension is associated with poor short-term outcome, although the results have been conflicting. Our objective was to evaluate the association of blood pressure (BP) and in-hospital outcomes in patients with acute ischaemic stroke.
METHODS AND RESULTS
Patients in the Get With The Guidelines-Stroke registry with acute ischaemic stroke were included. Admission systolic and diastolic BP was used to compute mean arterial pressure (MAP) and pulse pressure (PP). The outcomes of interest were: in-hospital mortality, not discharged home, inability to ambulate independently at discharge and haemorrhagic complications due to thrombolytic therapy. A total of 309 611 patients with an ischaemic stroke were included. There was a J-shaped/U-shaped relationship between systolic BP and outcomes. Both lower and higher systolic BP values, compared with a central reference value, had higher risk of in-hospital death [e.g. adjusted odds ratio (95% confidence interval) (OR[CI]) = 1.16[1.13-1.20] for 120 vs. 150 mmHg and 1.24[1.19-1.30] for 200 vs. 150 mmHg], not discharged home (OR[CI] = 1.11[1.09-1.13] for 120 vs. 150 mmHg and 1.15[1.12-1.18] for 200 vs. 150 mmHg), inability to ambulate independently at discharge (OR[CI] = 1.16[1.13-1.18] for 120 vs. 150 mmHg and 1.09[1.06-1.11] for 200 vs. 150 mmHg). However, risk of haemorrhagic complications of thrombolytic therapy was lower with lower systolic BP (OR[CI] = 0.89[0.83-0.97] for 120 vs. 150 mmHg), while higher with higher systolic BP (OR[CI] = 1.21[1.11-1.32] for 200 vs. 150 mmHg). The results were largely similar for admission diastolic BP, MAP, and PP.
CONCLUSION
In patients hospitalized with ischaemic stroke, J-shaped, or U-shaped relationships were observed between BP variables and short-term outcomes. However, haemorrhagic complications with thrombolytic therapy were lower with lower BP.
目的
卒中后高血压与短期预后不良相关，但结果存在争议。我们的目的是评估急性缺血性卒中患者的血压（BP）与院内结局的关系。
方法和结果
纳入 Get With The Guidelines-Stroke 登记处的急性缺血性卒中患者。入院时的收缩压和舒张压用于计算平均动脉压（MAP）和脉压（PP）。主要结局为院内死亡率、未出院回家、出院时不能独立行走和溶栓治疗所致出血性并发症。共纳入 309611 例缺血性卒中患者。收缩压与结局之间存在 J 形/倒 U 形关系。与中心参考值相比，较低和较高的收缩压值均增加院内死亡风险[例如，120 与 150mmHg 相比，调整后的比值比（95%置信区间）（OR[CI]）为 1.16[1.13-1.20]，200 与 150mmHg 相比，OR[CI]为 1.24[1.19-1.30]]，未出院回家（OR[CI]为 1.11[1.09-1.13]，120 与 150mmHg 相比，OR[CI]为 1.15[1.12-1.18]，200 与 150mmHg 相比），出院时不能独立行走（OR[CI]为 1.16[1.13-1.18]，120 与 150mmHg 相比，OR[CI]为 1.09[1.06-1.11]，200 与 150mmHg 相比）。然而，较低的收缩压与溶栓治疗的出血性并发症风险较低相关（OR[CI]为 0.89[0.83-0.97]，120 与 150mmHg 相比），而较高的收缩压与溶栓治疗的出血性并发症风险较高相关（OR[CI]为 1.21[1.11-1.32]，200 与 150mmHg 相比）。入院舒张压、MAP 和 PP 的结果基本相似。
结论
在因缺血性卒中住院的患者中，BP 变量与短期结局之间观察到 J 形或倒 U 形关系。然而，较低的 BP 与溶栓治疗的出血性并发症较低相关。
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