He Yitao, Yang Miaojuan, Che Sixuan, Chen Siyan, Jiang Xin, Guo Yi
Department of Neurology, Shenzhen People's Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, 518020, China.
Department of Cardiology, Shenzhen People's Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, 518020, China.
Clin Neurol Neurosurg. 2019 Sep;184:105420. doi: 10.1016/j.clineuro.2019.105420. Epub 2019 Jul 9.
To prospectively evaluate the effect of morning blood pressure peak (MBPP) on early progressive ischemic stroke (EPIS).
A total of 135 patients with acute ischemic stroke were enrolled and completed all assessments. The patients were divided into EPIS group and non-EPIS group, with 22 and 113 cases in each group, respectively, according to the assessment of Scandinavian stroke scale within three days after onset. All cases received conventional treatment for stroke and its risk factors. 24 -h dynamic blood pressure monitoring was performed within 24 h after admission. Based on the 24 -h mean blood pressure, MBPP, morning blood pressure, and other risk factors for EPIS, we conducted a logistic regression analysis to evaluate whether MBPP was an independent risk factor for EPIS.
Mean systolic blood pressure, systolic and diastolic MBPP, morning systolic and diastolic blood pressure were all significantly higher in EPIS group than in non-EPIS group (p = 0.037, p = 0.001, p = 0.035, p = 0.003, p = 0.042, respectively). Logistic regression analysis showed that MBPP was an independent risk factor for EPIS (OR = 1.057, 95% CI 1.014-1.102, p = 0.009). Further stratified analysis showed that incidences of EPIS in patients with elevated MBPP combined with large artery atherosclerosis or small artery occlusion were comparable (41.2% vs. 25.0%, p = 0.367), and the systolic MBPP was significantly higher in morning EPIS group than in non-morning EPIS group (p = 0.041).
Elevated systolic MBPP might be an independent risk factor for EPIS, and play a more obvious effect on EPIS manifesting in the morning especially.
前瞻性评估晨起血压峰值（MBPP）对早期进展性缺血性卒中（EPIS）的影响。
共纳入135例急性缺血性卒中患者并完成所有评估。根据发病后三天内的斯堪的纳维亚卒中量表评估，将患者分为EPIS组和非EPIS组，每组分别为22例和113例。所有病例均接受卒中及其危险因素的常规治疗。入院后24小时内进行24小时动态血压监测。基于24小时平均血压、MBPP、晨起血压及其他EPIS危险因素，我们进行了逻辑回归分析，以评估MBPP是否为EPIS的独立危险因素。
EPIS组的平均收缩压、收缩压和舒张压MBPP、晨起收缩压和舒张压均显著高于非EPIS组（p分别为0.037、0.001、0.035、0.003、0.042）。逻辑回归分析显示，MBPP是EPIS的独立危险因素（OR = 1.057，95%CI 1.014 - 1.102，p = 0.009）。进一步分层分析显示，MBPP升高合并大动脉粥样硬化或小动脉闭塞患者的EPIS发生率相当（41.2%对25.0%，p = 0.367），晨起EPIS组的收缩压MBPP显著高于非晨起EPIS组（p = 0.041）。
收缩压MBPP升高可能是EPIS的独立危险因素，尤其对晨起表现的EPIS影响更明显。
