Stroke：脑出血急性期进一步强化降压治疗或利于临床预后

急性脑出血患者的降压治疗时常规急性期处理的一部分。然而，降压治疗与临床预后的关系尚不明确。来自日本的Yuki Sakamoto等人研究了这方面的问题，在线发表在2013年5月23日的stroke杂志上，研究结果显示：脑出血急性期进一步强化降压治疗或利于临床预后。

该研究纳入脑出血超急性期（发病3小时内）初始收缩压超过180 mm Hg的患者。所有患者接受静脉降压治疗，基于预订的目标，血压降至120至160 mm Hg之间。在初始两小时内每15分钟测一次血压，在随后22小时内每小时测一次（总共测量30次）、平均收缩压为30次测量的收缩压的平均值，使用多因素logistic回归分析评价平均收缩压与神经功能恶化（定义为Glasgow昏迷评分下降超过两分，NIHSS评分增加超过4分）、血肿体积扩大（增加超过33%）及不良预后（3个月后改良Rankin指数4到6分）。

纳入的211例患者中，81例为女性患者，平均年龄为65岁（四分位间距为58-74岁），发病时初始NIHSS评分为13分（范围为8到17分），17例(8%)患者显示神经功能恶化，36例(17%)显示血肿扩大，87例(41%)显示出现不良预后。多元回归分析显示，在调整其他预测因素后，降压后的平均收缩压是神经功能恶化（平均收缩压每增加 10 mm Hg的优势比为4.45,95%可信区间为2.03–9.74），血肿扩大(1.86; 1.09–3.16)和不良预后(2.03; 1.24–3.33)的的独立危险因素。

超急性脑出血患者在使用标准降压治疗后获得的平均收缩压与临床不良预后相关。进一步增强降压治疗或可改善临床预后。

Systolic Blood Pressure After Intravenous Antihypertensive Treatment and Clinical Outcomes in Hyperacute Intracerebral Hemorrhage: The Stroke Acute Management With Urgent Risk-Factor Assessment and Improvement-Intracerebral Hemorrhage Study.
BACKGROUND AND PURPOSE
Blood pressure (BP) lowering is often conducted as part of general acute management in patients with acute intracerebral hemorrhage. However, the relationship between BP after antihypertensive therapy and clinical outcomes is not fully known.
METHODS
Hyperacute (<3 hours from onset) intracerebral hemorrhage patients with initial systolic BP (SBP) >180 mm Hg were included. All patients received intravenous antihypertensive treatment, based on predefined protocol to lower and maintain SBP between 120 and 160 mm Hg. BPs were measured every 15 minutes during the initial 2 hours and every 60 minutes in the next 22 hours (a total of 30 measurements). The mean achieved SBP was defined as the mean of 30 SBPs, and associations between the mean achieved SBP and neurological deterioration (≥2 points' decrease in Glasgow Coma Score or ≥4 points' increase in National Institutes of Health Stroke Scale score), hematoma expansion (>33% increase), and unfavorable outcome (modified Rankin Scale score 4-6 at 3 months) were assessed with multivariate logistic regression analyses.
RESULTS
Of the 211 patients (81 women, median age 65 [interquartile range, 58-74] years, and median initial National Institutes of Health Stroke Scale score 13 [8-17]) enrolled, 17 (8%) showed neurological deterioration, 36 (17%) showed hematoma expansion, and 87 (41%) had an unfavorable outcome. On multivariate regression analyses, mean achieved SBP was independently associated with neurological deterioration (odds ratio, 4.45; 95% confidence interval, 2.03-9.74 per 10 mm Hg increment), hematoma expansion (1.86; 1.09-3.16), and unfavorable outcome (2.03; 1.24-3.33) after adjusting for known predictive factors.
CONCLUSIONS
High achieved SBP after standardized antihypertensive therapy in hyperacute intracerebral hemorrhage was independently associated with poor clinical outcomes. Aggressive antihypertensive treatment may ameliorate clinical outcomes.