From the Department of Neurological Sciences (M.A.H.), University of Nebraska Medical Center, Omaha, NE; The George Institute for Global Health (C.A.), Faculty of Medicine, University of New South Wales, Sydney, Australia; The George Institute China at Peking University Health Science Center (C.A.), Beijing, PR China; and Department of Neurology (A.A.R.), Mayo Clinic, Rochester, MN.
Neurology. 2022 Jul 26;99(4):150-160. doi: 10.1212/WNL.0000000000200856. Epub 2022 Jun 3.
Blood pressure variability, the variation of blood pressure during a certain period, results from the interaction of hemodynamic, neuronal, humoral, behavioral, and environmental factors. Cerebral autoregulation is impaired in acute cerebrovascular disease. Hence, increased blood pressure variability (BPV) may provoke or exacerbate secondary brain injury. In fact, available data showed that increased blood pressure variability is associated with worse outcomes after acute ischemic stroke, intracerebral hemorrhage, and aneurysmal subarachnoid hemorrhage. Consequently, BPV may represent a usual modifiable therapeutic target. This concept is particularly attractive because reduction of BPV can be feasible in regions with lower resources and can be applicable to patients with various forms of acute stroke. Prospective studies are needed to further clarify the relationship between BPV and secondary brain damage and the determinants of BPV in different clinical populations. Ultimately, cerebrovascular disease-specific randomized controlled trials aimed at reducing BPV, irrespective of the absolute blood pressure values, are needed to determine whether reduction of BPV can improve outcomes in patients with acute cerebrovascular disease.
血压变异性是指在一定时间内血压的变化，它是由血流动力学、神经元、体液、行为和环境因素相互作用的结果。急性脑血管病患者的脑自动调节功能受损。因此，血压变异性（BPV）增加可能会引发或加重继发性脑损伤。事实上，现有数据表明，急性缺血性脑卒中、脑出血和颅内动脉瘤性蛛网膜下腔出血后，血压变异性增加与预后不良相关。因此，BPV 可能是一个常见的可治疗的靶点。这一概念特别有吸引力，因为在资源较少的地区降低 BPV 是可行的，并且适用于各种类型的急性脑卒中患者。需要前瞻性研究来进一步阐明 BPV 与继发性脑损伤之间的关系，以及不同临床人群中 BPV 的决定因素。最终，需要针对特定脑血管病的随机对照试验来降低 BPV，而不考虑血压的绝对值，以确定降低 BPV 是否可以改善急性脑血管病患者的预后。
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