급성기 뇌경색에서 혈압상승과 관련된 인자

Abstract

Background : Elevation of blood pressure(BP) is common in patients with acute ischemic stroke. Several studies have reported that a high plasma catecholamine level or a previous hypertension contributes to elevate blood pressure in acute ischemic strokes. However, comprehensive studies investigating various clinical parameters related to elevated BP are unavailable. The aim of this study was to investigate the clinical variables related to a BP elevation in patients with acute ischemic stroke. Methods : Acute(< 24 hr after the symptom onset), consecutive patients who were admitted to the emergency room and diagnosed as having cerebral infarction were investigated. A BP elevation was defined as a high systolic(> 200 mmHg) or diastolic(>110 mmHg) pressure. Possible factors related to elevated BP were investigated, which included stroke subtypes, lesion locations, the side of lesions, neurological symptoms, risk factors, stroke severity, vascular status and various laboratory abnormalities. Results : One hundred thirty-one patients were recruited(M:F=60:71, mean age 66+12 years) and an elevated BP was identified in 33 patients(25.2%). The mean BP did not differ significantly among the stroke subtypes, lesion locations, and hemispheric sides. According to univariate logistic regression, an elevated systolic BP correlated with headache(p=0.01) and underlying hypertension p=0.02) while an elevated diastolic BP was related with underlying hypertension(p=0.01). Multivariate logistic regression analysis revealed that previous hypertension(OR 5.21, 95% CI 1.40~19.37) and headache(OR 4.09, 95% CI 1.44~11.66) were independent predictors for elevated systolic BP. Conclusions : Headache and previous hypertension are independent predictors for systolic BP elevation in patients with acute ischemic stroke. Whether treatment of elevated BP improves headache and clinical outcome remains to be studied. (Korean Journal of Stroke 2002;4(2):72~77)