Kang Jihoon, Hong Jeong-Ho, Jang Min Uk, Choi Nack Cheon, Lee Ji Sung, Kim Beom Joon, Han Moon-Ku, Bae Hee-Joon
Department of Neurology, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Republic of Korea.
Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea.
PLoS One. 2017 Dec 18;12(12):e0189216. doi: 10.1371/journal.pone.0189216. eCollection 2017.
How short-term blood pressure variability (BPV) is affected in the acute stage of ischemic stroke and whether BPV is associated with early neurologic outcomes remains unclear.
Patients who admitted for ischemic stroke within 24 h of symptom onset were consecutively identified between January 2010 and January 2015. BP profiles measured in real-time were summarized into short-term, 24-h time intervals, based on standard deviation (SD) and mean of systolic BP (SBPSD) during the first 3 days. The primary outcome was daily assessment of early neurological deterioration (END). The associations between short-term SBPSD values and the secular trend for primary outcome were examined.
A total of 2,545 subjects (mean age, 67.1 ± 13.5 years old and median baseline National Institutes of Health Stroke Scale score, 3) arrived at the hospital an average of 6.1 ± 6.6 h after symptom onset. SBPSD values at day 1 (SD#D1), SD#D2, and SD#D3 were 14.4 ± 5.0, 12.5 ± 4.5, and 12.2 ± 4.6 mmHg, respectively. Multivariable analyses showed that SD#D2 was independently associated with onset of END at day 2 (adjusted odds ratio, 1.08; 95% confidence interval, 1.03-1.13), and SD#D3 was independently associated with END#D3 (1.07, 1.01-1.14), with adjustments for predetermined covariates, SBPmean, and interactions with daily SBPSD.
Short-term BPV changed and stabilized from the first day of ischemic stroke. Daily high BPV may be associated with neurological deterioration independent of BPV on the previous day.
缺血性卒中急性期短期血压变异性（BPV）如何受影响以及BPV是否与早期神经功能结局相关仍不清楚。
连续纳入2010年1月至2015年1月期间症状发作24小时内入院的缺血性卒中患者。根据症状发作后前3天收缩压的标准差（SD）和均值（SBPSD），将实时测量的血压概况总结为短期24小时时间间隔。主要结局是每日评估早期神经功能恶化（END）。研究短期SBPSD值与主要结局的长期趋势之间的关联。
共有2545名受试者（平均年龄67.1±13.5岁，基线美国国立卫生研究院卒中量表评分中位数为3）在症状发作后平均6.1±6.6小时到达医院。第1天（SD#D1）、第2天和第3天的SBPSD值分别为14.4±5.0、12.5±4.5和12.2±4.6 mmHg。多变量分析显示，SD#D2与第2天END的发生独立相关（调整优势比，1.08；95%置信区间，1.03 - 1.13），SD#D3与END#D3独立相关（1.07，1.01 - 1.14），对预先确定的协变量、SBPmean以及与每日SBPSD的相互作用进行了调整。
缺血性卒中第一天起短期BPV发生变化并趋于稳定。每日高BPV可能与神经功能恶化相关，且独立于前一日的BPV。
