血压变异性可能是缺血性脑卒中发生及预后的新预测因子

doi:10.24920/004219

摘要/Abstract

摘要：

尽管近年来发病率和死亡率有所下降，但缺血性脑卒中（ischemic stroke, IS）仍然是脑血管疾病致死、致残的主要原因之一。干预可控性危险因素是临床管理IS的基础。高血压是IS最常见的可治疗危险因素之一，并与不良结局有关。动态血压监测结果显示高血压患者的血压变异性（blood pressure variability, BPV）高于非高血压患者。同时，BPV升高已被证明是IS的危险因素。BPV越高，IS发生的风险越高，卒中后的预后越差，无论是在急性期还是亚急性期。BPV受多因素影响，其变化反映了个体的生理病理改变。本文综述了目前BPV与IS关系的研究进展，旨在提高临床医生和IS患者对BPV的认识，探讨BPV升高是IS的可控危险因素。对于高血压患者，不仅需要控制血压平均水平，同时需要关注血压变异性，以更好地开展个性化血压管理。

关键词: 血压变异性, 高血压, 缺血性脑卒中

Abstract:

Despite declines in morbidity and mortality in recent years, ischemic stroke (IS) remains one of the leading causes of death and disability from cerebrovascular diseases. Addressing the controllable risk factors underpins the successful clinical management of IS. Hypertension is one of the most common treatable risk factors for IS and is associated with poor outcomes. Ambulatory blood pressure monitoring has revealed that patients with hypertension have a higher incidence of blood pressure variability (BPV) than those without hypertension. Meanwhile, increased BPV has been identified as a risk factor for IS. The risk of IS is higher and the prognosis after infarction is worse with higher BPV, no matter in the acute or subacute phase. BPV is multifactorial, with alterations reflecting individual physiological and pathological changes. This article reviews the current research advances in the relationship between BPV and IS, with an attempt to raise awareness of BPV among clinicians and IS patients, explore the increased BPV as a controllable risk factor for IS, and encourage hypertensive patients to control not only average blood pressure but also BPV and implement personalized blood pressure management.

Key words: blood pressure variability, hypertension, ischemic stroke

基金资助: 重庆市自然科学基金(csct2020jcy-msxmX0765)

Ke-Qiong Yan, Qi-Si Wu, Jun Yang. Blood Pressure Variability May Be a New Predictor for the Occurrence and Prognosis of Ischemic Stroke[J].Chinese Medical Sciences Journal, 2023, 38(3): 242-249.

图/表 4

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Author citation	Size (n)	BPV measures	Findings
Minhas et al. ^[61]	11,093	CV	SBPV was significantly associated with poor outcomes in IS patients.
Kang et al. ^[62]	4,415	SD	For patients with IS, BPV but not mean BP increased the 1-year risk of major vascular events.
Chung et al.^[64]	1,161	SD, CV	BPV was significantly associated with worse neurologic outcomes after IS.
Dai et al. ^[65]	2,325	CV	IS recurrence was associated with both SBPV and DBPV.
Naito et al. ^[66]	626	SD, CV	The SD of SBP and DBP, CV of DBP, and morning BP surge were associated with poor outcomes for IS.
Zhang et al. ^[67]	592	SD, CV	SBPV was a critical predictor for short-term outcomes among patients with IS.
Martins et al. ^[68]	674	SD	SBPV showed an association with 3-month clinical outcome for IS.
Geng et al. ^[69]	704	SD, CV	SBPV was the strongest independent predictor of functional outcomes in IS patients.
de Havenon et al. ^[70]	1,891	SD, CV	Increased SBPV was associated with worse neurologic outcome after IS.
Kamieniarz-Medrygal et al. ^[73]	174	SD	In the acute phase of IS, the SD of BPV was robustly associated with 30-day outcomes.
Yong et al. ^[74]	615	Successive variation in the BP profile	DBPV was an independent predictor of outcomes in IS patients.
Yamamoto et al. ^[75]	105	[(mean daytime BP?mean nighttime BP)/average BP for 24 hours]×100%	Non-dipper BP had an adverse effect on the risk of recurrent IS and poor outcomes.
Dai et al. ^[76]	52,387	CV	Visit-to-visit BPV was associated with the mortality rate of cerebrovascular disease.
Fukuda et al. ^[77]	2,566	SD	Day-by-day BPV was associated with the 3-month functional outcome after acute IS.
Yang et al. ^[78]	367	SD, CV	Increased day-by-day SBPV or DBPV in the IS was associated with a higher risk for unfavorable outcome at 3 months, independent of mean BP levels.

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