Chamorro A, Vila N, Ascaso C, Elices E, Schonewille W, Blanc R
Neurology Service/IDIBAPS, Hospital Clínic, Barcelona, Spain.
Stroke. 1998 Sep;29(9):1850-3. doi: 10.1161/01.str.29.9.1850.
The relevance of elevated blood pressure in acute ischemic stroke and its most appropriate management are unresolved. We aimed to evaluate the rate of functional recovery with relation to early blood pressure management in patients with ischemic stroke.
Four hundred eighty-one consecutive ischemic stroke patients were admitted to the Neurology Service within 20.9+/-10.5 hours of symptoms onset as part of the Barcelona Downtown Stroke Registry, including 235 patients who received oral antihypertensive agents within <24 hours after stroke onset. Demographic, clinical (Mathew scale), and CT scan findings were collected prospectively. Mean arterial pressure (MAP) was recorded before hospital arrival and at 7 AM on days 1, 2, and 7 of hospitalization. The primary end point was complete functional recovery at day 7 defined as a score of 0 to 1 on the modified Rankin scale.
Two hundred fifty-two patients achieved complete recovery on day 7. Using logistic regression, independent predictors of complete recovery included mild impairment at stroke presentation, lack of history of hypertension, and absence of brain edema on CT scan. Also, a 20% to 30% drop in MAP on day 2 after stroke onset almost tripled the odds of full recovery (odds ratio, 2.9; 95% CI, 1.3 to 6.3). MAP tended to normalize after stroke in all subjects, more rapidly if hypotensive agents were administered. Brain edema was also less frequent in patients with a greater drop in blood pressure. Despite the fact that a drop in MAP >30% from baseline was observed in 49 patients, this preceded worsening stroke in only 4 patients. Conversely, worsening stroke occurred in 51 patients despite stable blood pressure.
These results suggest that complete recovery in ischemic stroke is facilitated by a moderate blood pressure reduction when brain edema develops, most likely as the result of a more adequate cerebral perfusion pressure. Conversely, stroke worsening due to pharmacological hypoperfusion is exceptional.
急性缺血性卒中时血压升高的相关性及其最合适的治疗方法尚未明确。我们旨在评估缺血性卒中患者早期血压管理与功能恢复率之间的关系。
作为巴塞罗那市中心卒中登记研究的一部分，481例连续的缺血性卒中患者在症状发作后20.9±10.5小时内入住神经内科，其中235例患者在卒中发作后<24小时内接受了口服抗高血压药物治疗。前瞻性收集人口统计学、临床（Mathew量表）和CT扫描结果。记录入院前以及住院第1、2和7天上午7点的平均动脉压（MAP）。主要终点是第7天完全功能恢复，定义为改良Rankin量表评分为0至1分。
252例患者在第7天实现了完全恢复。使用逻辑回归分析，完全恢复的独立预测因素包括卒中发作时轻度损伤、无高血压病史以及CT扫描无脑水肿。此外，卒中发作后第2天MAP下降20%至30%使完全恢复的几率几乎增加两倍（优势比，2.9；95%CI，1.3至6.3）。所有受试者卒中后MAP趋于正常，如果给予降压药物则恢复更快。血压下降幅度更大的患者脑水肿也较少见。尽管49例患者的MAP较基线下降>30%，但只有4例患者随后出现卒中恶化。相反，尽管血压稳定，仍有51例患者出现卒中恶化。
这些结果表明，当出现脑水肿时，适度降低血压有助于缺血性卒中的完全恢复，这很可能是由于脑灌注压更合适的结果。相反，因药物性低灌注导致的卒中恶化很罕见。
