Background and Aims

This study explores the relationship between systolic blood pressure (SBP) during the acute period of stroke and poor functional outcome in patients with lacunar stroke, emphasizing a possible time-dependent nature of the relationship.

Methods

Based on multicenter stroke registry data, patients with acute lacunar stroke were identified, and SBP levels at eight time points (1, 2, 4, 8, 16, 24, 48, and 72h) after stroke onset were extracted at the 15 participating centers in South Korea. Poor functional outcome was defined as a three-month modified Rankin Scale score of 2–6. Non-linear restricted cubic spline and linear models were used for assessing the relationship at each time point.

Results

A total of 97,349 SBP measurements of 3,042 patients were analyzed. At 1h and 4h after stroke onset, the relationship between SBP and poor outcome showed a non-linear association. The nadir was 155 mmHg at 1h and 124 mmHg at 4h. After this time period, a higher SBP was associated with a poorer outcome. This linear relationship weakened over time after 12h (coefficient values of the adjusted linear models: 0.0081 at 8h, 0.0105 at 12h, 0.0102 at 24h, 0.0082 at 48h, 0.0054 at 72h).

Conclusions

Based on our cohort of large number of lacunar stroke patients, our findings suggest that SBP levels may follow a time-dependent course in relation to prediction of outcome at 3 months. The findings may be valuable for hypothesis generation in association with clinical trial development for blood pressure control in acute stroke patients.

背景和目标

本研究探讨了卒中急性期收缩压 (SBP) 与腔隙性卒中患者不良功能预后之间的关系，强调了这种关系可能具有时间依赖性。

方法

根据多中心卒中登记数据，确定急性腔隙性卒中患者，并在 15 个参与中心提取卒中发作后 8 个时间点（1、2、4、8、16、24、48 和 72 小时）的 SBP 水平在韩国。较差的功能结果被定义为 3 个月修正的 Rankin 量表评分为 2-6。非线性限制三次样条和线性模型用于评估每个时间点的关系。

结果

共分析了 3,042 名患者的 97,349 次 SBP 测量值。在卒中发作后 1 小时和 4 小时，SBP 与不良预后之间的关系呈非线性关联。最低点在 1 小时为 155 mmHg，在 4 小时为 124 mmHg。在这段时间之后，较高的 SBP 与较差的结果相关。这种线性关系在 12 小时后随时间减弱（调整后的线性模型的系数值：8 小时为 0.0081，12 小时为 0.0105，24 小时为 0.0102，48 小时为 0.0082，72 小时为 0.0054）。

结论

基于我们大量腔隙性卒中患者的队列，我们​​的研究结果表明 SBP 水平可能遵循与 3 个月结果预测相关的时间依赖性过程。这些发现可能对产生与急性卒中患者血压控制临床试验开发相关的假设有价值。