抗高血压治疗在脑梗死急性期的疗效——一项前瞻性随机对照试验
Efficacy of Antihypertensive Therapy in the Acute Stage of Cerebral Infarction - A Prospective, Randomized Control Trial.
作者信息
Li Youjia, Zhong Zhigeng, Luo Songbao, Han Xiaoyan, Liang Yuchan, Huang Genlin, Zhou Weikun, Ding Qiong, Huang Yan, Wu Zhenmei
机构信息
Department of Neurology, The First People's Hospital of Zhaoqing, Guangdong Province, China.
出版信息
Acta Cardiol Sin. 2018 Nov;34(6):502-510. doi: 10.6515/ACS.201811_34(6).20180622B.
BACKGROUND
This study investigated whether patients in the acute stage of cerebral infarction (ACI) might benefit from single-drug antihypertensive therapy (AT) without the use of preset target levels.
METHODS
A total of 320 ACI patients were randomly divided into an AT group and a control group (group C) (160 patients in each group). The AT group received single antihypertensive drug treatment after the first 48 hours of onset with 5 mg of amlodipine besylate or 150 mg of irbesartan once a day. The primary end-point event was mortality on the 14 day and in the 6 month after onset, significant dependent-survival status (SDS, Barthel Index ≤ 60), mortality/disability ratio (modified Rankin Scale ≥ 3), and recurrence rate of cardio-cerebral vascular events (RR-CVE).
RESULTS
The National Institutes of Health Stroke Scale (NIHSS) score was 8.39 ± 3.21 vs. 8.16 ± 3.27 in the AT and C groups on entry to the study. On day 14, there were no significant differences in mortality (2.5% vs. 3.1%, p = 0.9994), SDS (50.0% vs. 49.0%, p = 0.864), and mortality/disability ratio (61.3% vs. 66.3%, p = 0.352) between the two groups, however the RR-CVE in the AT group was lower than in group C (4.4% vs. 11.9%, p = 0.014). In month 6, there were no significant difference in mortality rate between the two groups (3.1% vs. 3.8%, p = 0.767), however the SDS (23.4% vs. 34.4%, p = 0.033), mortality/disability ratio (32.1% vs. 45.0%, p = 0.018), and RR-CVE in group AT were lower than in group C (10.7% vs. 19.4%, p = 0.030).
CONCLUSIONS
Appropriate AT for patients with ACI does not worsen the disease condition and may improve the prognosis for the patients with moderate or mild stroke severity.
背景
本研究调查了急性脑梗死（ACI）患者在不设定目标血压水平的情况下，单药降压治疗（AT）是否有益。
方法
总共320例ACI患者被随机分为AT组和对照组（C组）（每组160例患者）。AT组在发病48小时后接受单药降压治疗，每日服用5毫克苯磺酸氨氯地平或150毫克厄贝沙坦。主要终点事件为发病后14天和6个月时的死亡率、显著依赖生存状态（SDS，巴氏指数≤60）、死亡率/残疾率（改良Rankin量表≥3）以及心脑血管事件复发率（RR-CVE）。
结果
研究入组时，AT组和C组的美国国立卫生研究院卒中量表（NIHSS）评分分别为8.39±3.21和8.16±3.27。在第14天，两组在死亡率（2.5%对3.1%，p = 0.9994）、SDS（50.0%对49.0%，p = 0.864）和死亡率/残疾率（61.3%对66.3%，p = 0.352）方面无显著差异，但AT组的RR-CVE低于C组（4.4%对11.9%，p = 0.014）。在第6个月，两组的死亡率无显著差异（3.1%对3.8%，p = 0.767），但AT组的SDS（23.4%对34.4%，p = 0.033）、死亡率/残疾率（32.1%对45.0%，p = 0.018）和RR-CVE低于C组（10.7%对19.4%，p = 0.030）。
结论
对ACI患者进行适当的AT不会使病情恶化，可能改善中轻度卒中严重程度患者的预后。
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