Department of Internal Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece.
J Clin Neurosci. 2024 Jul;125:51-58. doi: 10.1016/j.jocn.2024.05.014. Epub 2024 May 15.
The management of blood pressure (BP) and the role of antihypertensive medications (AHT) in acute ischemic stroke (AIS) remain uncertain. This study aimed to investigate the impact of pre- and intra-stroke AHT use on systolic (SBP), diastolic (DBP), and blood pressure variability (BPV).
A post-hoc analysis was conducted on 228 AIS patients from the PREVISE study. All patients underwent 24-hour ambulatory blood pressure monitoring within 48 h of symptom onset. Clinical and laboratory data, as well as AHT details, were recorded. Mean BP parameters and BPV for SBP and DBP were computed. The study endpoint was 3-month mortality.
The majority of stroke patients (84.2%) were already taking AHTs. Beta blockers and ACE inhibitors use before and after stroke were linked to higher DBP variability. Prior angiotensin receptor blockers (ARBs) and vasodilators use correlated with increased SBP variability and lower daytime SBP/DBP levels, respectively. The continuation, discontinuation, or change of AHTs after stroke onset did not significantly affect outcomes. Patients under AHTs during AIS exhibited reduced mortality, with those previously using calcium channel blockers experiencing less severe strokes, and those previously using ARBs showing better outcomes at three months.
These findings advocate for personalized BP management in AIS, based on a patient's antihypertensive history. These insights could enhance treatment efficacy, guide research, and improve care for acute ischemic stroke patients.
血压（BP）的管理以及降压药物（AHT）在急性缺血性卒中（AIS）中的作用仍存在不确定性。本研究旨在探讨AIS 前和发病时使用 AHT 对收缩压（SBP）、舒张压（DBP）和血压变异性（BPV）的影响。
对 PREVISE 研究中的 228 例 AIS 患者进行了一项事后分析。所有患者在发病后 48 小时内接受了 24 小时动态血压监测。记录了临床和实验室数据以及 AHT 详细信息。计算了 SBP 和 DBP 的平均 BP 参数和 BPV。研究终点为 3 个月死亡率。
大多数卒中患者（84.2%）已经在服用 AHT。AIS 前和后使用β受体阻滞剂和 ACE 抑制剂与 DBP 变异性增加相关。先前使用血管紧张素受体阻滞剂（ARB）和血管扩张剂与 SBP 变异性增加和白天 SBP/DBP 水平降低相关。AIS 后继续、停止或改变 AHTs 对结局没有显著影响。在 AIS 期间使用 AHT 的患者死亡率降低，先前使用钙通道阻滞剂的患者卒中严重程度较低，先前使用 ARB 的患者在三个月时的结局更好。
这些发现提倡根据患者的降压治疗史，对 AIS 患者进行个体化的 BP 管理。这些见解可以增强治疗效果，指导研究，并改善急性缺血性卒中患者的护理。
