基线血压水平与急性缺血性脑卒中早期降压治疗3个月结局的关系

The relationship between baseline blood pressure and 3 months outcome of early antihypertensive therapy in acute ischemic stroke

目的探讨基线血压水平与急性缺血性脑卒中早期降压治疗3 m结局关系。方法收集2009年8月-2013年5月发病48 h内住院且经影像学确诊合并高血压的急性期缺血性脑卒中患者828例,根据入组时收缩压(Systolic Blood Pressure,SBP)水平分为140~160 mmHg组(n=276)、160~180 mmHg组(n=350)、180~200 mmHg组(n=158)、200~220 mmHg组(n=44),随机给予降压治疗或不予降压治疗。降压治疗者24 h内降压10%~20%,收缩压和舒张压在7 d分别低于140 mmHg和90 mmHg,并在2 w内维持在这一水平。不予降压治疗者停止或不给予降压药物,所有患者测量并记录血压水平。比较患者出院后3 m死亡率和良好预后率。结果随访3 m,140~160 mmHg组降压治疗患者死亡率明显高于无降压治疗患者(13.7%vs 5.8%,P<0.05),良好预后率明显低于无降压治疗患者(65.5%vs 77.4%,P<0.05),160~180 mmHg组、180~200 mmHg组、200~220 mmHg组死亡率比较差异无统计学意义(9.2%vs 13.4%,11.8%vs 12.3%13.6%vs 9.1%,P>0.05),良好预后率比较差异亦无统计学意义(71.8%vs 62.6%,69.4%vs 60.3%,54.5%vs 59.1%,P>0.05)。结论急性缺血性脑卒中患者轻度血压升高时(SBP 140~160 mmHg)不宜降压治疗;中高度血压升高时(SBP 160~220 mmHg)降压治疗对3 m结局影响是中性的。

Objective To explore the outcome relationship between the baseline blood pressure level and the early antihypertensive therapy of acute ischemic stroke for 3 months.Methods A total of 828 patients who were admitted to hospital within 48 hours of onset and diagnosed with acute ischemic stroke with hypertension through imageological examination from August 2009 to May 2013 were collected.They were divided into 140~160 mmHg group(n=276),160~180 mmHg group(n=350),180~200 mmHg group(n=158),and 200~220 mmHg group(n=44)according to the level of systolic pressure at the time of enrollment,and given randomly or not given antihypertensive therapy.For the patients receiving the antihypertensive therapy,the blood pressure was reduced by 10%~20%within 24 hours,the systolic pressure and diastolic pressure were lower than 140 mmHg and 90 mmHg respectively at 7 days,and maintained at this level for 2 weeks.For the patients not receiving the antihypertensive therapy,antihypertensive drugs were discontinued or not given,and all patients were measured,with the blood pressure levels recorded.The mortality and good prognosis rate were compared at 3 months after discharge.Results Through 3 months of follow-up,the mortality of patients with antihypertensive therapy in the 140~160 mmHg group was significantly higher than that of those without antihypertensive therapy(13.7%vs 5.8%,P<0.05),the good prognosis rate was significantly lower than that of those without antihypertensive therapy(65.5%vs 77.4%,P<0.05),there was no statistically significant difference in mortality and all-cause mortality between 160~180 mmHg group,180~200 mmHg group,and 200~220 mmHg group(9.2%vs 13.4%,11.8%vs 12.3%,13.6%vs 9.1%,P>0.05),and the difference in good prognosis rate was not statistically significant(71.8%vs 62.6%,69.4%vs 60.3%,54.5%vs 59.1%,P>0.05).Conclusion Patients with acute ischemic stroke should not receive antihypertensive therapy when blood pressure is elevated mildly(SBP 140~160 mmHg);the impact of antihypertensive therapy on 3-month outcome is neutral in case of moderate to high blood pressure elevation(SBP 160~220 mmHg).