Department of Neurology, Emory University School of Medicine and Grady Memorial Hospital, 49 Jesse Hill Jr. Dr. SE, Atlanta, GA 30303, USA.
Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM, USA.
J Stroke Cerebrovasc Dis. 2020 Nov;29(11):105211. doi: 10.1016/j.jstrokecerebrovasdis.2020.105211. Epub 2020 Aug 7.
Acute management of blood pressure in ischemic stroke treated with reperfusion therapy remains uncertain. We evaluated blood pressures during the first 24-hours after reperfusion therapy in relation to in-hospital outcomes.
We conducted a single-center retrospective study of blood pressure in the first 24 hours among ischemic stroke patients who underwent reperfusion therapy with intravenous thrombolysis (IVT) or mechanical thrombectomy (MT) at a tertiary referral center. Blood pressure variability was expressed as the range between the highest and the lowest pressures. Outcomes of interest were discharge disposition and in-hospital mortality. Favorable outcome was defined as a discharge destination to home or inpatient rehabilitation facility (IRF). Multivariable logistic regression analysis was performed with adjustment for age, National Institutes of Health Stroke Scale score, and patients receiving reperfusion therapy.
Among the 140 ischemic stroke patients (117 IVT, 84 MT and 61 both), 95 (67.8%) had favorable discharge disposition and 24 (17.1%) died. Higher 24-hour peak systolic blood pressures (SBPs) and peak mean arterial pressures (MAPs) were independently associated with a lower likelihood of favorable discharge disposition, with an adjusted odds ratio (aOR) 0.868, 95 % CI 0.760 - 0.990 per 10 mm Hg for SBP and aOR 0.710, 95% CI 0.515 - 0.980 for MAP, and with increased odds of death aOR 1.244, 95% CI 1.056-1.467 and aOR 1.760, 95% CI 1.119 - 2.769 respectively. Greater variability of SBP and MAP was also associated with odds of death aOR 1.327, 95% CI 1.104 - 1.595 and aOR 1.577, 95% CI 1.060- 2.345 respectively, without a significant effect on discharge disposition.
In the first 24 hours after reperfusion therapy, higher peak and variable blood pressures are associated with unfavorable discharge outcomes and increased in-hospital mortality. Further studies in stroke patients undergoing reperfusion therapy might target blood pressure reduction and variability to improve patient outcomes.
接受再灌注治疗的缺血性卒中患者的血压急性期管理仍存在不确定性。我们评估了再灌注治疗后 24 小时内的血压与住院结局的关系。
我们对在一家三级转诊中心接受静脉溶栓（IVT）或机械取栓（MT）治疗的缺血性卒中患者，在再灌注治疗后 24 小时内的血压进行了单中心回顾性研究。血压变异性表示为最高和最低血压之间的范围。感兴趣的结局是出院去向和住院死亡率。多变量逻辑回归分析调整了年龄、国立卫生研究院卒中量表评分和接受再灌注治疗的患者。
在 140 例缺血性卒中患者（117 例 IVT、84 例 MT 和 61 例同时接受两种治疗）中，95 例（67.8%）出院时预后良好，24 例（17.1%）死亡。较高的 24 小时收缩压（SBP）峰值和平均动脉压（MAP）峰值与预后不良的可能性较低独立相关，SBP 每增加 10mmHg 的调整后比值比（aOR）为 0.868，95%可信区间（CI）为 0.760-0.990，MAP 的 aOR 为 0.710，95%CI 为 0.515-0.980，死亡风险增加 aOR 为 1.244，95%CI 为 1.056-1.467，aOR 为 1.760，95%CI 为 1.119-2.769。SBP 和 MAP 的变异性增加也与死亡风险相关，aOR 为 1.327，95%CI 为 1.104-1.595，aOR 为 1.577，95%CI 为 1.060-2.345，对出院去向无显著影响。
在再灌注治疗后的 24 小时内，较高的峰值血压和血压变异性与不良的出院结局和住院死亡率增加相关。进一步研究接受再灌注治疗的卒中患者可能需要降低血压和血压变异性以改善患者结局。
