Department of Cardiovascular Science, University of Leicester, Leicester, UK.
The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
J Hum Hypertens. 2019 May;33(5):411-418. doi: 10.1038/s41371-019-0193-z. Epub 2019 Mar 20.
The Head Positioning in Acute Stroke Trial (HeadPoST) is a pragmatic, international, cluster crossover randomized trial of 11,093 patients with acute stroke assigned to a lying-flat (0°) or sitting-up (head elevated ≥30°) position. This post hoc analysis aimed to determine the association between blood pressure variability (BPV) and outcomes for patients from a wide range of international clinical settings and how the association was modified by randomized head position. BPV was defined according to the standard criteria, with the key parameter considered the coefficient of variation (CV) of systolic BP (SBP) over 24 h. Outcome was ordinal 90-day Modified Rankin Scale (mRS) score. The association was analyzed by ordinal, logistic regression, hierarchical, mixed models with fixed intervention (lying flat vs. sitting up), and fixed period, random cluster, and random cluster-period, effects. Nine thousand one hundred and fifty six (8324 acute ischemic stroke and 817 intracerebral hemorrhage; mean age 68.1 years; 39.2% women) were included in the analysis. CV of SBP had a significant linear association with unfavorable shift of mRS at 90 days (adjusted odds ratio 1.06, 95% confidence interval 1.02-1.11; P = 0.01). There was no heterogeneity of the association by randomized head positioning. In addition, CV of diastolic BP (DBP) (1.08, 1.03-1.12; P = 0.001) over 24 h post stroke was significantly associated with 3-month poor outcome. The association was more apparent in sitting-up position (1.12, 1.06-1.19) compared with lying-flat position (1.03, 0.98-1.09) (P interaction = 0.005). BPV was associated with adverse stroke outcome, and the magnitude of the association was greater with sitting-up head positioning in terms of DBP variability.
头部定位在急性脑卒中试验（HeadPoST）中，这是一项实用的、国际性的、集群交叉随机试验，涉及 11093 名急性脑卒中患者，他们被分为平卧位（0°）或坐位（头部抬高≥30°）。本事后分析旨在确定来自广泛国际临床环境的患者血压变异性（BPV）与结局之间的关联，以及这种关联如何因随机头部位置而改变。BPV 根据标准标准定义，关键参数为 24 小时内收缩压（SBP）的变异系数（CV）。结局为 90 天改良 Rankin 量表（mRS）评分的 ordinal 。通过 ordinal 、logistic 回归、层次、固定干预（仰卧位与坐位）的混合模型以及固定期、随机聚类、随机聚类期的随机效应分析关联。共有 9156 名患者（8324 名急性缺血性脑卒中，817 名脑出血；平均年龄 68.1 岁；39.2%为女性）纳入分析。SBP 的 CV 与 90 天 mRS 的不利变化呈显著线性关联（调整后的优势比为 1.06，95%置信区间为 1.02-1.11；P=0.01）。随机头部定位对关联没有异质性。此外，卒中后 24 小时舒张压（DBP）的 CV（1.08，1.03-1.12；P=0.001）与 3 个月的不良预后显著相关。与仰卧位（1.03，0.98-1.09）相比，坐位时的关联更为明显（1.12，1.06-1.19）（P 交互=0.005）。BPV 与不良卒中结局相关，从 DBP 变异性的角度来看，仰卧位头部定位时的关联程度更大。
