Association Between Hyperacute Stage Blood Pressure Variability and Outcome in Patients With Spontaneous Intracerebral Hemorrhage

被引：106

作者：

Chung, Pil-Wook ^{[1
]}

Kim, Joon-Tae ^{[2
]}

Sanossian, Nerses ^{[3
]}

Starkmann, Sidney ^{[4
]}

Hamilton, Scott ^{[8
]}

Gornbein, Jeffrey ^{[6
]}

Conwit, Robin ^{[9
]}

Eckstein, Marc ^{[10
,11
]}

Pratt, Frank ^{[12
]}

Stratton, Sam

Liebeskind, David S. ^{[5
,7
]}

Saver, Jeffrey L. ^{[5
,7
]}

机构：

[1] Sungkyunkwan Univ, Kangbuk Samsung Hosp, Sch Med, Dept Neurol, 108 Pyung Dong, Seoul 03181, South Korea

[2] Chonnam Natl Univ Hosp, Dept Neurol, Gwangju, South Korea

[3] Univ Southern Calif, Dept Neurol, Los Angeles, CA USA

[4] Univ Calif Los Angeles, David Geffen Sch Med, Comprehens Stroke Ctr, Div Emergency Med, Los Angeles, CA 90095 USA

[5] Univ Calif Los Angeles, David Geffen Sch Med, Dept Neurol, Los Angeles, CA 90095 USA

[6] Univ Calif Los Angeles, David Geffen Sch Med, Dept Biomath, Los Angeles, CA 90095 USA

[7] Univ Calif Los Angeles, David Geffen Sch Med, Comprehens Stroke Ctr, Los Angeles, CA 90095 USA

[8] Stanford Univ, Sch Med, Stanford, CA USA

[9] Natl Inst Neurol Disorders & Stroke, Bethesda, MD USA

[10] Univ Southern Calif, Keck Sch Med, Dept Emergency Med, Los Angeles, CA 90033 USA

[11] Los Angeles Fire Dept, Los Angeles, CA USA

[12] Los Angeles Cty Dept Publ Hlth, Los Angeles, CA USA

来源：

STROKE | 2018年 / 49卷 / 02期

基金：

美国国家卫生研究院;

关键词：

blood pressure; cerebral hemorrhage; humans; odds ratio; stroke; POST-HOC ANALYSIS; ACUTE STROKE; PROGNOSTIC-SIGNIFICANCE; HEMATOMA GROWTH; MANAGEMENT; PREDICTORS; THERAPY; TRIAL; HYPERTENSION; METHODOLOGY;

D O I：

10.1161/STROKEAHA.117.017701

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose-Increased blood pressure (BP) variability, in addition to high BP, may contribute to adverse outcome in intracerebral hemorrhage. However, degree and association with outcome of BP variability (BPV) in the hyperacute period, 15 minutes to 5 hours after onset, have not been delineated. Methods-Among consecutive patients with intracerebral hemorrhage enrolled in the FAST-MAG trial (Field Administration of Stroke Therapy-Magnesium), BPs were recorded by paramedics in the field and during the first 24 hours of hospital course. BP was analyzed in the hyperacute period, from 0 to 4-6 hours, and in the acute period, from 0 to 24-26 hours after onset. BPV was analyzed by SD, coefficient of variation, and successive variation. Results-Among 386 patients with intracerebral hemorrhage, first systolic BP at median 23 minutes (interquartile range, 14-38.5) after onset was median 176 mmHg, second systolic BP on emergency department arrival at 57 minutes (interquartile range, 45-75) after onset was 178 mmHg, and systolic BP 24 hours after arrival was 138 mmHg. Unfavorable outcome at 3 months (modified Rankin Scale, 3-6) occurred in 270 (69.9%). Neither mean nor maximum systolic BP was associated with outcome in multivariable analysis. However, all 3 parameters of BPV, in both the hyperacute and the acute stages, were associated with poor outcome. In the hyperacute phase, BPV was associated with poor outcome with adjusted odds ratios of 3.73 for the highest quintile of SD, 4.78 for the highest quintile of coefficient of variation, and 3.39 for the highest quintile of successive variation. Conclusions-BPV during the hyperacute first minutes and hours after onset in patients with intracerebral hemorrhage was independently associated with poor functional outcome. Stabilization of BPV during this vulnerable period, in the pre-hospital and early emergency department course, is a potential therapeutic target for future clinical trials.

引用

页码：348 / 354

页数：7

共 22 条

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