Department of Neurology.
Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.
J Hypertens. 2019 Oct;37(10):2104-2109. doi: 10.1097/HJH.0000000000002154.
High blood pressure (BP) is associated with a poor outcome after acute stroke. Early reduction in BP may be associated with fewer early adverse events and deaths, and improved functional outcome.
Analyses used data from the Efficacy of Nitric Oxide in Stroke trial, a multicentre randomized single-masked and outcome-masked trial of glyceryl trinitrate vs. no glyceryl trinitrate in 4011 patients recruited within 48 h of an ischaemic or haemorrhagic stroke and with raised SBP (140-220 mmHg). Change in SBP from baseline to day 1 was categorized as: more than 15% decrease, 15-5% decrease, 5% decrease to 5% increase (no change - reference) and more than 5% increase. The primary outcome was functional outcome (modified Rankin scale) score at 90 days.
Across all patients, both moderate (5-15%) and large (>15%) decreases in SBP were associated with beneficial shifts in the modified Rankin scale relative to patients with no change in BP: adjusted common odds ratio (OR) 0.81 [95% confidence interval (CI) 0.70-0.90] and OR 0.84 (95% CI 0.71-1.00), respectively. A moderate decrease in SBP was also associated with a lower risk of early adverse events, adjusted OR 0.69 (95% CI 0.52-0.90).
Modest decreases in SBP in acute stroke appear to be associated with fewer early events and better long-term functional outcome.
高血压（BP）与急性中风后不良预后有关。早期降低 BP 可能与更少的早期不良事件和死亡以及改善的功能预后相关。
分析使用了来自 Efficacy of Nitric Oxide in Stroke 试验的数据，该试验是一项多中心随机单盲和结果盲试验，比较了 4011 名缺血性或出血性中风后 48 小时内 SBP（140-220mmHg）升高的患者接受甘油三硝酸酯与不接受甘油三硝酸酯治疗。从基线到第 1 天 SBP 的变化分为：减少 15%以上、减少 15-5%、减少 5%至增加 5%（无变化-参考）和增加 5%以上。主要结局是 90 天时的功能结局（改良 Rankin 量表）评分。
在所有患者中，SBP 适度（5-15%）和大幅下降（>15%）都与改良 Rankin 量表的有益变化相关，与 BP 无变化的患者相比：调整后的常见优势比（OR）分别为 0.81（95%置信区间（CI）0.70-0.90）和 0.84（95% CI 0.71-1.00）。SBP 的适度下降也与早期不良事件的风险降低相关，调整后的 OR 为 0.69（95% CI 0.52-0.90）。
急性中风时 SBP 的适度下降似乎与更少的早期事件和更好的长期功能预后相关。
