Neurology：双臂血压差与急性缺血性卒中患者的预后相关

两臂血压差（IAD）值对急性缺血性卒中的预后价值以及它与全身性动脉粥样硬化的相关性尚不清楚。韩国CHA Bundang医学中心的Jinkwon Kim博士等人进行了一项研究，研究结果发表在2013年4月16日的Neurology杂志上。研究结果显示：两臂收缩压或舒张压差值≥10 mm Hg 是急性缺血性卒中的一个强的独立预后标志。

该研究以医院为基础的回顾性观察性研究。研究人员收集急性缺血性卒中患者的存活情况及收缩/舒张压ICD。全身性动脉粥样硬化的判定依据冠脉CTA、经食道心脏超声、踝臂血压指数监测及脑血管成像（涵盖脑动脉的颅内段和颅外段）。

研究结果显示：834位患者中，10.3%的患者收缩压IAD≥10 mm Hg, 而6.0% 舒张压IAD ≥10 mm Hg。在平均随访2.96 ± 0.95 年后，92位患者死亡(包括68位因心血管疾病死亡)。在多变量Cox回归中，校正了心血管危险因素及发病时的卒中严重程度后，收缩压IAD ≥10 mm Hg与增加的全因死亡率 (风险比[HR] 1.97, 95%可信区间[CI] 1.16–3.35)及因心血管疾病死亡发生率(HR 2.49, 95% CI 1.39–4.46) 相关。舒张压IAD ≥10 mm Hg也增加全因死亡率风险(HR 3.43, 95% CI 1.94–6.08)及因心血管疾病死亡发生率(HR 3.51, 95% CI 1.83–6.74)。收缩压或舒张压IAD ≥10 mm Hg 与下肢外周动脉疾病相关，而与脑动脉、冠状动脉及主动脉的粥样硬化无关。

该研究发现：两臂收缩压或舒张压差值≥10 mm Hg 是急性缺血性卒中的一个强的独立预后标志。

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Interarm blood pressure difference and mortality in patients with acute ischemic stroke.
OBJECTIVE
The objective of this study was to assess the prognostic value of interarm difference of blood pressure (IAD) measured in acute ischemic stroke and to investigate its association with systemic atherosclerosis.
METHODS
This was a hospital-based retrospective observational study. Survival data and systolic/diastolic IAD were collected in patients with acute ischemic stroke. Systemic atherosclerosis was determined based on coronary CT angiography, transesophageal echocardiography, ankle-brachial index examination, and cerebral angiography covering both intracranial and extracranial cerebral arteries.
RESULTS
Of 834 patients, 10.3% had a systolic IAD ≥10 mm Hg, and 6.0% had a diastolic IAD ≥10 mm Hg. During a mean follow-up period of 2.96 ± 0.95 years, 92 patients died (including 68 cardiovascular deaths). In multivariate Cox regression adjusted for cardiovascular risk factors and initial stroke severity, the presence of systolic IAD ≥10 mm Hg was associated with increased risk of all-cause mortality (hazard ratio [HR] 1.97, 95% confidence interval [CI] 1.16-3.35) and cardiovascular mortality (HR 2.49, 95% CI 1.39-4.46). Patients with diastolic IAD ≥10 mm Hg also had increased risk of all-cause mortality (HR 3.43, 95% CI 1.94-6.08) and cardiovascular mortality (HR 3.51, 95% CI 1.83-6.74). The presence of systolic or diastolic IAD ≥10 mm Hg was associated with peripheral artery disease in the lower limbs, but not with atherosclerosis in the cerebral artery, coronary artery, or the aorta.
CONCLUSIONS
The presence of interarm systolic or diastolic blood pressure difference ≥10 mm Hg is a strong independent prognostic marker in acute ischemic stroke.