Department of Neurosurgery; Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon 200-704, Korea.
Department of Neurology, Hallym University College of Medicine, Chuncheon 200-704, Korea.
Chin Med J (Engl). 2018 Mar 20;131(6):657-664. doi: 10.4103/0366-6999.226886.
: Blood pressure (BP) variability has been associated with stroke risk. We elucidated the association between systolic BP (SBP) variation and outcomes in patients with nonlobar intracerebral hemorrhage (ICH) following intensive antihypertensive treatment upfront.
We screened consecutive patients with spontaneous ICH who underwent intensive antihypertensive treatments targeting BP <140 mmHg between 2008 and 2016. SBPs were monitored hourly during the acute period (≤7 days after symptom onset) in the intensive care unit. SBP variability was determined in terms of range, standard deviation (SD), coefficient of variation (CoV), and mean absolute change (MAC). The primary outcomes included hematoma growth and poor clinical outcome at 3 months (modified Rankin Scale [mRS] score ≥3. The secondary outcome was an ordinal shift in mRS at 3 months.
A total of 104 individuals (mean age, 63.0 ± 13.5 years; male, 57.7%) were included in this study. In multivariable model, MAC (adjusted odds ratio [OR], 1.11; 95% confidence interval [CI]: 1.02-1.21; P = 0.012) rather than the range of SD or CoV, was significantly associated with hematoma growth even after adjusting for mean SBP level. Sixty-eight out of 104 patients (65.4%) had a poor clinical outcome at 3 months. SD and CoV of SBP were significantly associated with a 3-month poor clinical outcome even after adjusting for mean SBP. In addition, in multivariable ordinal logistic models, the MAC of SBP was significantly associated with higher shift of mRS at 3 months (adjusted OR, 1.08; 95% CI: 1.02-1.15; P = 0.008).
: The MAC of SBP is associated with hematoma growth, and SD and COV are correlated with 3-month poor outcome in patients with supratentorial nonlobar ICH. Therefore, sustained SBP control, with a reduction in SBP variability is essential to reinforce the beneficial effect of intensive antihypertensive treatment.
血压（BP）变异性与卒中风险相关。我们阐明了在强化降压治疗后，非脑叶颅内出血（ICH）患者的收缩压（SBP）变化与结局之间的关系。
我们筛选了 2008 年至 2016 年间接受强化降压治疗（目标血压＜140mmHg）的自发性 ICH 连续患者。在重症监护病房（ICU）中，急性期（发病后≤7 天）每小时监测 SBP。SBP 变异性用范围、标准差（SD）、变异系数（CoV）和平均绝对变化（MAC）来确定。主要结局包括血肿增大和 3 个月时的不良临床结局（改良 Rankin 量表[mRS]评分≥3）。次要结局是 3 个月时 mRS 的等级变化。
共有 104 例患者（平均年龄 63.0±13.5 岁，男性 57.7%）纳入本研究。在多变量模型中，MAC（调整后比值比[OR]，1.11；95%置信区间[CI]：1.02-1.21；P=0.012）而不是 SD 或 CoV 的范围，与血肿增大显著相关，即使在调整平均 SBP 水平后也是如此。104 例患者中有 68 例（65.4%）在 3 个月时临床结局不良。即使在调整平均 SBP 后，SBP 的 SD 和 CoV 与 3 个月时的不良临床结局显著相关。此外，在多变量有序逻辑模型中，SBP 的 MAC 与 3 个月时 mRS 的更高变化显著相关（调整后 OR，1.08；95%CI：1.02-1.15；P=0.008）。
SBP 的 MAC 与血肿增大相关，SD 和 CoV 与非脑叶幕上 ICH 患者 3 个月时的不良结局相关。因此，持续控制 SBP，降低 SBP 变异性对于强化降压治疗的有益作用至关重要。
