Hung Stanley H, Tierney Christopher, Klassen Tara D, Schneeberg Amy, Bayley Mark T, Dukelow Sean P, Hill Michael D, Krassioukov Andrei, Pooyania Sepideh, Poulin Marc J, Yao Jennifer, Eng Janice J
Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
Rehabilitation Research Program, Center for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
Front Neurol. 2023 Sep 19;14:1245881. doi: 10.3389/fneur.2023.1245881. eCollection 2023.
High blood pressure (BP) is the primary risk factor for recurrent strokes. Despite established clinical guidelines, some stroke survivors exhibit uncontrolled BP over the first 12 months post-stroke. Furthermore, research on BP trajectories in stroke survivors admitted to inpatient rehabilitation hospitals is limited. Exercise is recommended to reduce BP after stroke. However, the effect of high repetition gait training at aerobic intensities (>40% heart rate reserve; HRR) during inpatient rehabilitation on BP is unclear. We aimed to determine the effect of an aerobic gait training intervention on BP trajectory over the first 12 months post-stroke.
This is a secondary analysis of the Determining Optimal Post-Stroke Exercise (DOSE) trial. Participants with stroke admitted to inpatient rehabilitation hospitals were recruited and randomized to usual care ( = 24), DOSE1 ( = 25; >2,000 steps, 40-60% HRR for >30 min/session, 20 sessions over 4 weeks), or DOSE2 ( = 25; additional DOSE1 session/day) groups. Resting BP [systolic (SBP) and diastolic (DBP)] was measured at baseline (inpatient rehabilitation admission), post-intervention (near inpatient discharge), 6- and 12-month post-stroke. Linear mixed-effects models were used to examine the effects of group and time (weeks post-stroke) on SBP, DBP and hypertension (≥140/90 mmHg; ≥130/80 mmHg, if diabetic), controlling for age, stroke type, and baseline history of hypertension.
No effect of intervention group on SBP, DBP, or hypertension was observed. BP increased from baseline to 12-month post-stroke for SBP (from [mean ± standard deviation] 121.8 ± 15.0 to 131.8 ± 17.8 mmHg) and for DBP (74.4 ± 9.8 to 78.5 ± 10.1 mmHg). The proportion of hypertensive participants increased from 20.8% ( = 15/72) to 32.8% ( = 19/58). These increases in BP were statistically significant: an effect [estimation (95%CI), value of ] of time was observed on SBP [0.19 (0.12-0.26) mmHg/week, < 0.001], DBP [0.09 (0.05-0.14) mmHg/week, < 0.001], and hypertension [OR (95%CI): 1.03 (1.01-1.05), = 0.010]. A baseline history of hypertension was associated with higher SBP by 13.45 (8.73-18.17) mmHg, higher DBP by 5.57 (2.02-9.12) mmHg, and 42.22 (6.60-270.08) times the odds of being hypertensive at each timepoint, compared to those without.
Blood pressure increased after inpatient rehabilitation over the first 12 months post-stroke, especially among those with a history of hypertension. The 4-week aerobic gait training intervention did not influence this trajectory.
高血压是复发性中风的主要危险因素。尽管有既定的临床指南，但一些中风幸存者在中风后的前12个月内血压控制不佳。此外，对于入住住院康复医院的中风幸存者的血压轨迹研究有限。建议通过运动来降低中风后的血压。然而，住院康复期间进行有氧强度（>40%心率储备；HRR）的高重复步态训练对血压的影响尚不清楚。我们旨在确定有氧步态训练干预对中风后前12个月血压轨迹的影响。
这是对确定最佳中风后运动（DOSE）试验的二次分析。招募入住住院康复医院的中风患者，并将其随机分为常规护理组（n = 24）、DOSE1组（n = 25；步数>2000步，HRR为40 - 60%，每次训练>30分钟，4周内进行20次训练）或DOSE2组（n = 25；每天额外增加一次DOSE1训练）。在基线（住院康复入院时）、干预后（住院即将出院时）、中风后6个月和12个月测量静息血压[收缩压（SBP）和舒张压（DBP）]。使用线性混合效应模型来检验组和时间（中风后周数）对SBP、DBP和高血压（≥140/90 mmHg；糖尿病患者为≥130/80 mmHg）的影响，并控制年龄、中风类型和高血压基线病史。
未观察到干预组对SBP、DBP或高血压有影响。从基线到中风后12个月，SBP（从[均值±标准差]121.8±15.0 mmHg升至131.8±17.8 mmHg）和DBP（从74.4±9.8 mmHg升至78.5±10.1 mmHg）均升高。高血压参与者的比例从20.8%（n = 15/72）增至32.8%（n = 19/58）。这些血压升高具有统计学意义：观察到时间对SBP[0.19（0.12 - 0.26）mmHg/周，P < 0.001]、DBP[0.09（0.05 - 0.14）mmHg/周，P < 0.001]和高血压[比值比（95%置信区间）：1.03（1.01 - 1.05），P = 0.010]有影响。与无高血压病史者相比，高血压基线病史与每次测量时SBP升高13.45（8.73 - 18.17）mmHg、DBP升高5.57（2.02 - 9.12）mmHg以及高血压几率高42.22（6.60 - 270.08）倍相关。
中风后前12个月住院康复期间血压升高，尤其是有高血压病史者。为期4周的有氧步态训练干预未影响这一轨迹。
