Blood Pressure Variability and Ischemic Stroke Outcome (BP-VISO)

血压变异性和缺血性中风结果 (BP-VISO)

• 批准号: 10564945
• 负责人: Adam H. de Havenon
• 金额: $ 60.08万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-01 至 2027-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10564945
• 关键词: Acute; Address; Adrenergic beta-Antagonists; Affect; Age; Alteplase; American; Anterior; Antihypertensive Agents; Autonomic nervous system; Blood Pressure; Calcium Channel Blockers; Cessation of life; Circulation; Clinical; Cognition; Data; Dedications; Elements; Enrollment; Ethnic Origin; Fingers; Future; Goals; Growth; Guidelines; Hemorrhage; Home; Hospitalization; Hospitals; Hour; Impaired cognition; Individual; Infarction; Intervention; Intravenous; Ischemic Stroke; Knowledge; Link; MRI Scans; Magnetic Resonance Imaging; Measurement; Measures; Methods; Morbidity - disease rate; Outcome; Patients; Pharmaceutical Preparations; Photoplethysmography; Positioning Attribute; Public Health; Pupil light reflex; Race; Regimen; Research; Site; Stroke; Surrogate Markers; Testing; Therapeutic; United States; United States National Institutes of Health; arm; blood pressure elevation; blood pressure reduction; blood pressure variability; cognitive change; disability; disability risk; endovascular thrombectomy; experience; functional outcomes; health care settings; high risk; mortality; novel; novel strategies; pharmacologic; portability; post stroke; post stroke cognitive impairment; prospective; radiological imaging; sex; standard of care; stroke intervention; stroke outcome; stroke patient; thrombolysis; transmission process

PROJECT SUMMARY/ABSTRACT Stroke affects 800,000 Americans every year and remains a leading cause of long-term disability. Increased blood pressure variability (BPV) has consistently been associated with two to three times higher risk of disability or mortality after acute ischemic stroke (AIS) in retrospective analyses, independent of mean blood pressure. Our central hypothesis is that increased BPV is harmful after AIS and warrants reduction. However, prior BPV research in AIS patients has been retrospective and limited by non-standardized BP measurement and, therefore, BPV is not mentioned in current stroke guidelines. To address the limitations of prior BPV research, determine mechanisms of BPV's deleterious effect, and identify potentially effective methods to reduce BPV, the proposed study will: 1) prospectively validate that “short-term” and “long-term” BPV after AIS onset is associated with functional outcome and define the effect size of different levels of BPV, 2) utilize portable MRI to confirm that final infarct volume, infarct growth and hemorrhagic transformation between baseline (measured within 12 hours of hospital arrival) and 72 hours are mechanistically related to BPV, and 3) utilize bedside pupillometry to determine how the autonomic nervous system contributes to BPV after AIS and evaluate the class effect of antihypertensive medications on BPV. To achieve these goals, we will enroll 150 patients who have anterior circulation stroke and a baseline NIH Stroke Scale ≥6 within 12 hours of AIS onset at three study sites. With completion of the Aims, we will define the outcome for a future trial (disability at 90 days vs. infarct volume or HT vs. post-stroke cognitive impairment at 12 months vs. composites), the effect size of BPV on individual outcomes and composites, the duration for lowering BPV (24-72 hours vs. weeks or months), and potential interventions to reduce BPV. Pharmacologic BPV reduction would be an inexpensive and widely available intervention, able to be administered in a range of healthcare settings. By completing the proposed Aims, we will be ideally positioned to test accessible targeted interventions to diminish the morbidity and mortality of AIS.

项目摘要/摘要 中风每年影响80万美国人，并且仍然是长期残疾的主要原因。增加 血压变异性（BPV）一直与残疾风险高两到三倍 在回顾性分析中，急性缺血性中风（AIS）后的死亡率与平均血压无关。 我们的中心假设是，在AIS和保证减少后，BPV增加是有害的。但是，先前的BPV AIS患者的研究是回顾性的，并且受非标准的BP测量和限制 因此，目前的中风指南中未提及BPV。为了解决先前BPV研究的局限性， 确定BPV有害作用的机制，并确定潜在的有效方法来减少BPV， 拟议的研究将：1）前瞻性验证AIS发作后的“短期”和“长期” BPV与 具有功能结果并定义了不同级别BPV的效果大小，2）使用便携式MRI确认 最终的梗塞量，梗塞生长和基线之间的出血转化（在12中测量 医院到达的时间）和72小时与BPV机械有关，3）将床边的化学测定法 确定自主神经系统在AIS后如何促进BPV并评估类别的效果 BPV的降压药。为了实现这些目标，我们将招募150名患有抗尿液的患者 在三个研究地点，在AIS发作的12小时内，循环中风和基线NIH中风量≥6。和 目的的完成，我们将定义未来试验的结果（90天的残疾与梗塞量或HT 与复合材料相对于复合材料而言，中风后认知障碍），BPV的效果对个别结果的影响 和组成，降低BPV的持续时间（24-72小时与周或几个月）以及潜在的干预措施 减少BPV。减少药理BPV将是一种便宜且可用的干预措施，能够 在一系列医疗机构中进行管理。通过完成提议的目标，我们将是理想情况下 定位于测试可访问的目标干预措施，以降低AIS的发病率和死亡率。