Tang Tao, Zhang Guang, Chen Zhongjun, Thomas Aline M, Zhou Jianxin, Li Shen
Department of Neurology and Psychiatry, Emergency and Critical Care Medical Center, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Beijing, 100038, China.
Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
Intern Emerg Med. 2025 Apr;20(3):701-708. doi: 10.1007/s11739-024-03853-8. Epub 2024 Dec 30.
Reverse dipping blood pressure, generally regarded as a pathological condition, is frequently observed in patients with acute stroke. We aimed to assess the association of reverse dipping blood pressure with in-hospital mortality among critically ill patients with ischemic stroke. This is a retrospective study of patients in the Medical Information Mart for Intensive Care IV database with ischemic stroke requiring intensive care unit admission. Diurnal (9:00-21:00) and nocturnal (1:00-6:00) mean arterial pressures (MAPs) were collected. Reverse dipping was defined as having an average nocturnal MAP higher than the average diurnal MAP. Multivariable binary logistic regression analysis was used to assess the association of reverse dipping with in-hospital mortality. A total of 2080 patients (median age, 73 years; 50.3% female) were enrolled, among which 681 patients (32.7%) had reverse dipping. Patients with reverse dipping blood pressure had a higher in-hospital mortality compared to those without (19.8% vs. 11.4%, p < 0.001). After adjusting for potential confounders, reverse dipping was associated with a higher likelihood of in-hospital mortality (adjusted OR, 1.59; 95% CI 1.21-2.11; p = 0.001). Reverse dipping blood pressure was associated with a higher mortality rate among critically ill patients with ischemic stroke. The circadian rhythm of blood pressure should warrant more attention in cerebrovascular neurocritical care.
血压反勺型变化通常被视为一种病理状态，在急性卒中患者中经常观察到。我们旨在评估缺血性卒中重症患者血压反勺型变化与院内死亡率之间的关联。这是一项对重症监护医学信息数据库IV中需要入住重症监护病房的缺血性卒中患者的回顾性研究。收集了日间（9:00 - 21:00）和夜间（1:00 - 6:00）的平均动脉压（MAP）。血压反勺型变化定义为夜间平均MAP高于日间平均MAP。采用多变量二元逻辑回归分析来评估血压反勺型变化与院内死亡率之间的关联。共纳入2080例患者（中位年龄73岁；50.3%为女性），其中681例患者（32.7%）存在血压反勺型变化。血压呈反勺型变化的患者与无此变化的患者相比，院内死亡率更高（19.8%对11.4%，p < 0.001）。在对潜在混杂因素进行校正后，血压反勺型变化与院内死亡可能性更高相关（校正后的OR为1.59；95%置信区间为1.21 - 2.11；p = 0.001）。血压反勺型变化与缺血性卒中重症患者的死亡率较高相关。在脑血管神经重症监护中，血压的昼夜节律应引起更多关注。
