Castilla-Guerra L, Domínguez Mayoral A, González-Iglesias L, Fernández-Moreno M C, Rico-Corral M A
Unidad de Hipertensión Arterial, Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Virgen Macarena, Sevilla, España; Departamento de Medicina, Universidad de Sevilla, Sevilla, España.
Servicio de Neurología, Hospital Virgen Macarena, Sevilla, España.
Hipertens Riesgo Vasc. 2022 Apr-Jun;39(2):56-61. doi: 10.1016/j.hipert.2022.01.003. Epub 2022 Feb 12.
High morning BP surge (MBPS) has been associated with an increased risk of cardiovascular events. We evaluated the presence of a high MBPS in patients with recent ischaemic stroke.
A case-control study was carried out. One hundred patients with an ischaemic stroke in the previous 6 months and fifty hypertensive patients without cardiovascular disease were included as controls.
61 lacunar (LAC) and 39 non-lacunar (NLAC) strokes were studied. The mean age was 65±11 years, and 60 (40%) patients were women. High MBPS was present in 9% of strokes (in 5 LAC and 4 NLAC) and in 8% of controls (p not significant [NS]), with a similar mean value of MBPS in both groups: 23.9±14mmHg and 24.9±15mmHg respectively (p=NS), although the control patients had a higher office BP (systolic [p=.008] and diastolic [p=.0001]), 24h systolic BP (p=.028) and daytime systolic BP (p=.022). Among the stroke patients, high MBPS was associated with previous coronary heart disease (p=.005), circadian BP pattern (p=.029), but not with the type of antihypertensive treatment prescribed. In multivariate analysis, elevated MBPS was only associated with previous coronary artery disease (p=.001).
Approximately one in ten patients with recent ischaemic stroke has a high MBPS. Strategies to detect and treat high MBPS after a stroke are needed.
清晨血压急升（MBPS）与心血管事件风险增加相关。我们评估了近期缺血性卒中患者中MBPS升高的情况。
开展了一项病例对照研究。纳入100例在过去6个月内发生缺血性卒中的患者，以及50例无心血管疾病的高血压患者作为对照。
研究了61例腔隙性（LAC）卒中和39例非腔隙性（NLAC）卒中。平均年龄为65±11岁，60例（40%）患者为女性。9%的卒中患者（5例LAC和4例NLAC）存在MBPS升高，8%的对照者存在MBPS升高（p无显著性差异[NS]），两组MBPS的平均值相似：分别为23.9±14mmHg和24.9±15mmHg（p=NS），尽管对照患者的诊室血压较高（收缩压[p=0.008]和舒张压[p=0.0001]）、24小时收缩压（p=0.028）和日间收缩压（p=0.022）。在卒中患者中，MBPS升高与既往冠心病（p=0.00）、昼夜血压模式（p=0.029）相关，但与所开抗高血压治疗类型无关。多因素分析显示，MBPS升高仅与既往冠心病相关（p=0.001）。
近期缺血性卒中患者中约十分之一存在MBPS升高。需要采取策略来检测和治疗卒中后的MBPS升高。
