Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, China.
Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
J Clin Hypertens (Greenwich). 2020 Feb;22(2):194-204. doi: 10.1111/jch.13785. Epub 2020 Feb 12.
This study discusses the association between blood pressure (BP) variability at different time periods within first 24 hours after admission and the functional outcome in acute ischemic stroke (AIS). We observed BP variability within first 24 hours after admission and evaluated the association between BP variability at different time periods (4 am-8 am, 10 am-2 pm, 4 pm-8 pm, 10 pm-2 am) and the functional outcome in AIS. National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were applied to evaluate short- (7 days) and long-term functional outcome. The 24 hours after admission and early morning (4 am-8 am) systolic blood pressure (SBP) variability were associated with poor outcome at day 7 (adjusted OR = 1.567, 95% CI = 1.076-2.282; adjusted OR = 1.507, 95% CI = 1.028-2.209, respectively). Compared with the impact of the 24-hour BP variability on long-term functional outcome, the early morning SBP was proved to be a strongly independent predictor for functional outcome at 3 months (adjusted OR = 1.505, 95% CI = 1.053-2.152), 6 months (adjusted OR = 1.560, 95% CI = 1.048-2.226), and 12 months (adjusted OR = 1.689, 95% CI = 1.104-2.584). The BP variability in other time period groups was shown to have no influence on functional outcome. In addition, attempts to explain early morning BP variability with baseline characteristic factors at admission found that baseline SBP is the most influential (2.71%) factor. About 95.87% of the SBP variability in early morning was unexplained. In our study, early morning SBP variability is the strongest independent predictor for functional outcome in (AIS) patients, and baseline SBP after admission should be monitored as a control indicator of early morning SBP variability in the treatment of AIS patients.
本研究探讨了急性缺血性脑卒中（AIS）患者入院后 24 小时内不同时间段的血压（BP）变异性与功能结局之间的关系。我们观察了入院后 24 小时内的 BP 变异性，并评估了不同时间段（4 点-8 点、10 点-2 点、4 点-8 点、10 点-2 点）的 BP 变异性与 AIS 患者功能结局之间的关系。采用国立卫生研究院卒中量表（NIHSS）和改良 Rankin 量表（mRS）评估短期（7 天）和长期功能结局。入院后 24 小时和清晨（4 点-8 点）收缩压（SBP）变异性与第 7 天不良结局相关（校正 OR=1.567，95%CI=1.076-2.282；校正 OR=1.507，95%CI=1.028-2.209）。与 24 小时 BP 变异性对长期功能结局的影响相比，清晨 SBP 被证明是 3 个月（校正 OR=1.505，95%CI=1.053-2.152）、6 个月（校正 OR=1.560，95%CI=1.048-2.226）和 12 个月（校正 OR=1.689，95%CI=1.104-2.584）功能结局的独立强预测因素。其他时间组的 BP 变异性对功能结局没有影响。此外，试图用入院时的基线特征因素来解释清晨 BP 变异性，发现基线 SBP 是最具影响力的（2.71%）因素。清晨 SBP 变异性中约有 95.87%无法解释。在本研究中，清晨 SBP 变异性是 AIS 患者功能结局的最强独立预测因素，入院后应监测基线 SBP，作为 AIS 患者清晨 SBP 变异性治疗的控制指标。
