Abstract：
BACKGROUND: We performed an analysis of a large intensive care unit electronic database to provide preliminary estimates of various blood pressure parameters in patients with acute stroke receiving intravenous (IV) antihypertensive medication and determine the relationship with in-hospital outcomes.
METHODS: We identified the relationship between pre-treatment and post-treatment systolic blood pressure (SBP) and heart rate (HR)-related variables and in-hospital mortality and acute kidney injury in patients with acute stroke receiving IV clevidipine, nicardipine, or nitroprusside using data provided in the Medical Information Mart for Intensive Care (MIMIC) IV database.
RESULTS: A total of 1830 patients were treated with IV clevidipine (n = 64), nicardipine (n = 1623), or nitroprusside (n = 143). The standard deviations [SDs] of pre-treatment SBP (16.3 vs. 13.7, p ≤ 0.001) and post-treatment SBP (15.4 vs. 14.4, p = 0.004) were higher in patients who died compared with those who survived, particularly in patients with intracerebral hemorrhage (ICH). The mean SBP was significantly lower post treatment compared with pre-treatment values for clevidipine (130.7 mm Hg vs. 142.5 mm Hg, p = 0.006), nicardipine (132.8 mm Hg vs. 141.6 mm Hg, p ≤ 0.001), and nitroprusside (126.2 mm Hg vs. 139.6 mm Hg, p ≤ 0.001). There were no differences in mean SDs post treatment compared with pre-treatment values for clevidipine (14.5 vs. 13.5, p = 0.407), nicardipine (14.2 vs. 14.6, p = 0.142), and nitroprusside (14.8 vs. 14.8, p = 0.997). The SDs of pre-treatment and post-treatment SBP were not significantly different in patients with ischemic stroke treated with IV clevidipine, nicardipine, or nitroprusside or for patients with ICH treated with IV clevidipine or nitroprusside. However, patients with ICH treated with IV nicardipine had a significantly higher SD of post-treatment SBP (13.1 vs. 14.2, p = 0.0032).
CONCLUSIONS: We found that SBP fluctuations were associated with in-hospital mortality in patients with acute stroke. IV antihypertensive medication reduced SBP but did not reduce SBP fluctuations in this observational study. Our results highlight the need for optimizing therapeutic interventions to reduce SBP fluctuations in patients with acute stroke.
METHODS: We identified the relationship between pre-treatment and post-treatment systolic blood pressure (SBP) and heart rate (HR)-related variables and in-hospital mortality and acute kidney injury in patients with acute stroke receiving IV clevidipine, nicardipine, or nitroprusside using data provided in the Medical Information Mart for Intensive Care (MIMIC) IV database.
RESULTS: A total of 1830 patients were treated with IV clevidipine (n = 64), nicardipine (n = 1623), or nitroprusside (n = 143). The standard deviations [SDs] of pre-treatment SBP (16.3 vs. 13.7, p ≤ 0.001) and post-treatment SBP (15.4 vs. 14.4, p = 0.004) were higher in patients who died compared with those who survived, particularly in patients with intracerebral hemorrhage (ICH). The mean SBP was significantly lower post treatment compared with pre-treatment values for clevidipine (130.7 mm Hg vs. 142.5 mm Hg, p = 0.006), nicardipine (132.8 mm Hg vs. 141.6 mm Hg, p ≤ 0.001), and nitroprusside (126.2 mm Hg vs. 139.6 mm Hg, p ≤ 0.001). There were no differences in mean SDs post treatment compared with pre-treatment values for clevidipine (14.5 vs. 13.5, p = 0.407), nicardipine (14.2 vs. 14.6, p = 0.142), and nitroprusside (14.8 vs. 14.8, p = 0.997). The SDs of pre-treatment and post-treatment SBP were not significantly different in patients with ischemic stroke treated with IV clevidipine, nicardipine, or nitroprusside or for patients with ICH treated with IV clevidipine or nitroprusside. However, patients with ICH treated with IV nicardipine had a significantly higher SD of post-treatment SBP (13.1 vs. 14.2, p = 0.0032).
CONCLUSIONS: We found that SBP fluctuations were associated with in-hospital mortality in patients with acute stroke. IV antihypertensive medication reduced SBP but did not reduce SBP fluctuations in this observational study. Our results highlight the need for optimizing therapeutic interventions to reduce SBP fluctuations in patients with acute stroke.
摘要：
背景：我们对大型重症监护病房电子数据库进行了分析，以提供接受静脉（IV）抗高血压药物治疗的急性卒中患者的各种血压参数的初步估计，并确定与住院结局的关系。
方法：我们确定了治疗前和治疗后收缩压（SBP）和心率（HR）相关变量与住院死亡率和急性肾损伤之间的关系尼卡地平,或硝普钠使用医疗信息集市重症监护(MIMIC)IV数据库中提供的数据。
结果：总共1830例患者接受了IV氯维地平治疗（n=64），尼卡地平（n=1623），或硝普钠（n=143）。预处理SBP的标准偏差[SDs](16.3vs.13.7，p≤0.001）和治疗后SBP（15.4vs.14.4，p=0.004）与存活的患者相比，死亡的患者更高，特别是脑出血（ICH）患者。与氯维地平治疗前相比，治疗后的平均SBP显着降低（130.7mmHgvs.142.5mmHg,p=0.006),尼卡地平（132.8mmHgvs.141.6mmHg,p≤0.001)，和硝普钠(126.2mmHgvs.139.6mmHg,p≤0.001)。与氯维地平治疗前相比，治疗后的平均SDs值没有差异（14.5vs.13.5，p=0.407），尼卡地平（14.2vs.14.6，p=0.142），和硝普钠（14.8vs.14.8,p=0.997)。静脉注射氯维地平治疗的缺血性卒中患者治疗前和治疗后SBP的SDs无显著差异,尼卡地平,或硝普钠或静脉注射氯维地平或硝普钠治疗的ICH患者。然而,IV尼卡地平治疗的ICH患者治疗后SBP的SD显着升高（13.1vs.14.2，p=0.0032）。
结论：我们发现SBP波动与急性卒中患者的住院死亡率相关。在这项观察性研究中，IV降压药可降低SBP，但未降低SBP波动。我们的结果强调了优化治疗干预措施以减少急性卒中患者SBP波动的必要性。
方法：我们确定了治疗前和治疗后收缩压（SBP）和心率（HR）相关变量与住院死亡率和急性肾损伤之间的关系尼卡地平,或硝普钠使用医疗信息集市重症监护(MIMIC)IV数据库中提供的数据。
结果：总共1830例患者接受了IV氯维地平治疗（n=64），尼卡地平（n=1623），或硝普钠（n=143）。预处理SBP的标准偏差[SDs](16.3vs.13.7，p≤0.001）和治疗后SBP（15.4vs.14.4，p=0.004）与存活的患者相比，死亡的患者更高，特别是脑出血（ICH）患者。与氯维地平治疗前相比，治疗后的平均SBP显着降低（130.7mmHgvs.142.5mmHg,p=0.006),尼卡地平（132.8mmHgvs.141.6mmHg,p≤0.001)，和硝普钠(126.2mmHgvs.139.6mmHg,p≤0.001)。与氯维地平治疗前相比，治疗后的平均SDs值没有差异（14.5vs.13.5，p=0.407），尼卡地平（14.2vs.14.6，p=0.142），和硝普钠（14.8vs.14.8,p=0.997)。静脉注射氯维地平治疗的缺血性卒中患者治疗前和治疗后SBP的SDs无显著差异,尼卡地平,或硝普钠或静脉注射氯维地平或硝普钠治疗的ICH患者。然而,IV尼卡地平治疗的ICH患者治疗后SBP的SD显着升高（13.1vs.14.2，p=0.0032）。
结论：我们发现SBP波动与急性卒中患者的住院死亡率相关。在这项观察性研究中，IV降压药可降低SBP，但未降低SBP波动。我们的结果强调了优化治疗干预措施以减少急性卒中患者SBP波动的必要性。
