缺血性卒中急性期降压治疗对血压变异性与临床预后的影响

Effects of antihypertensive therapy on blood pressure variability and clinical outcome in patients with acute ischemic stroke

目的：阐明缺血性卒中急性期降压治疗对血压变异性及临床预后的影响。方法本卒中注册研究前瞻性纳入873例发病前神经功能正常，且发病时间在24 h以内的首次急性缺血性卒中患者，根据入院时血压水平分为静脉降压组、口服降压组和观察组。计算24 h收缩压变异系数（CV），并将其分为5段统计。发病3个月的临床预后分为恢复良好、功能恶化和预后不良。结果 CV≤4．0段的恢复良好概率最高，伴有最低的功能恶化与预后不良风险，调整潜在的混淆因素后这种关系照样存在。C－统计CV对恢复良好、功能恶化和预后不良的odds比值比（OR ）值分别是0．567，1．566和1．699。结论脑梗死急性期降压治疗具有同步降低收缩压／舒张压和血压变异性的双重作用，静脉给药效果更佳；血压变异性越小临床预后越好。国际临床试验注册号：ChiCTR－TRC－14004804。

Objective To explore the effects of antihypertensive therapy on blood pressure variability and the neurological prognosis in patients with acute ischemic stroke .Methods Among the patients in the Registry ,873 patients with first-ever acute ischemic stroke （within 24 hours of onset） who were functionally independent before onset were prospectively enrolled in the present study ,and were divided into intravenous antihypertensive group ,oral antihypertensive group and observation group based on admission blood pressure .Calculating the coefficient of variation （CV） within 24 hours ,and were divided into five sections go on analyzing .The clinical outcome at 3 month after onset was divided into a good neurological recovery ,neurological deterioration ,and a poor functional outcome .Results The highest probability of good neurological recovery was associated with the lowest risk of neurological deterioration and poor functional outcome at the levels of CV≤4 .0 ,it was still exist even if removing age-gender and potentially confounding factors .Through the C-statistics ,the odds ratios of CV were 0 .567 ,1 .566 and 1 .699 at a good neurological recovery ,neurological deterioration ,and poor functional outcome respectively .Conclusions Antihypertensive treatment at acute phase of stroke have the dual role that lowering systolic /diastolic and blood pressure variability .Intravenous administration is better;the smaller of blood pressure variability ,the better of clinical prognosis .Clinical Trial RegistrationURL ：http：//www .Chictr .org .Unique identifier：ChiCTR-TRC-14004804 .