From the Seoul National University College of Medicine (J.-A.S.); Department of Neurology, Cerebrovascular Center (K.-J.L., J.K., B.J.K., M.-K.H., J.Y.K., M.S.J., M.H.Y., H.-J.B.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Biostatistics (J.L.), Korea University, Seoul; and Davee Department of Neurology (P.B.G.), Northwestern University Feinberg School of Medicine, Chicago, IL.
Neurology. 2020 Sep 8;95(10):e1362-e1371. doi: 10.1212/WNL.0000000000010203. Epub 2020 Jul 8.
To evaluate whether the relationship between systolic blood pressure (SBP) and stroke outcome varies during the acute stage of ischemic stroke as a function of the elapsed time after stroke onset.
Patients who were hospitalized due to ischemic stroke within 6 hours of onset were retrospectively analyzed. SBP data were collected at 8 time points (1, 2, 4, 8, 16, 24, 48, and 72 hours after onset). The primary functional outcome measure was a poor outcome, defined as a modified Rankin Scale score of >2 at 3 months after stroke. Linear and quadratic models were constructed at each time point to assess relationships between SBP and outcome.
Of the 2,546 patients, 728 (28.6%) had a poor outcome. SBP, as either a linear or quadratic term, had a significant effect on functional outcome, except at 4 hours after onset. For the initial 2 hours after onset, SBP had nonlinear U-shaped relationships with functional outcome, and patients with SBP of approximately 165 mm Hg were the least likely to have a poor outcome. Quadratic models exhibited a significantly better model fit. For 8-24 hours postonset, SBP exhibited linear relationships with functional outcome. For 48-72 hours postonset, SBP exhibited a J-shaped relationship with functional outcome, and the predicted probability of poor outcome was the lowest in patients with SBP of approximately 125 mm Hg. These relationships were relatively consistent across various sensitivity analyses.
This study revealed that the relationship between SBP and functional outcome may depend on elapsed time from stroke onset.
评估收缩压（SBP）与卒中结局之间的关系是否会随着缺血性卒中发病后时间的推移而在急性阶段发生变化。
回顾性分析发病 6 小时内因缺血性卒中住院的患者。在 8 个时间点（发病后 1、2、4、8、16、24、48 和 72 小时）采集 SBP 数据。主要的功能结局指标为不良结局，定义为卒中后 3 个月改良 Rankin 量表评分＞2。在每个时间点构建线性和二次模型，以评估 SBP 与结局之间的关系。
在 2546 例患者中，728 例（28.6%）预后不良。SBP 无论是线性还是二次项，对功能结局都有显著影响，但在发病后 4 小时除外。在发病后最初 2 小时内，SBP 与功能结局呈非线性 U 型关系，SBP 约为 165mmHg 的患者最不可能预后不良。二次模型表现出更好的模型拟合度。在发病后 8-24 小时内，SBP 与功能结局呈线性关系。在发病后 48-72 小时内，SBP 与功能结局呈 J 型关系，SBP 约为 125mmHg 的患者不良结局的预测概率最低。这些关系在各种敏感性分析中相对一致。
本研究表明，SBP 与功能结局之间的关系可能取决于从卒中发病到就诊的时间。
