静脈動脈血圧のレベルは正常範囲内であり,再発性脳卒中のリスクがあります
Bruce Ovbiagele1, Hans-Christophe Diener, Salim Yusuf
1Department of Neurosciences, University of California, 9500 Gilman Dr, San Diego, CA 92093, USA. Ovibes@ucsd.edu
JAMA
|November 18, 2011
まとめ
最近の缺血性脳卒中の後,非常に低いシストリック血圧 (SBP) を120mmHg以下または非常に高いSBPを150mmHg以上維持すると,再発性脳卒中のリスクが増加します. 脳卒中予防のための最適なSBPは,高正常値 (130-140 mm Hg) の範囲にあるようです.
科学分野:
- 神経学 神経学とは
- 心臓病学 心臓病学
- クリニック・トライアル 臨床試験
背景:
- 再発性脳卒中予防ガイドラインは,シストリック血圧 (SBP) の有意な低下を提唱し,正常なSBPを120mmHg未満と定義しています.
- 非常に低いSBPを維持することで,血管疾患のリスクに与える影響は,脳卒中後に明らかになっていない.
研究 の 目的:
- 異なるシストリック血圧 (SBP) レベルと,最近の非心臓栓塞性不全性脳卒中の患者における再発性脳卒中のリスクとの関連を調べる.
主な方法:
- 最近発血性脳卒中を患った20,330人の患者 (年齢50歳以上) を対象とした多センター試験のポストホック観察分析.
- 患者は5つのSBPグループに分類されました:非常に低い正常 (<120mmHg),低い正常 (120-<130mmHg),高い正常 (130-<140mmHg),高い (140-<150mmHg),および非常に高い (≥150mmHg).
- フォローアップ期間は2.5年であり,主要なアウトカムとして再発性脳卒中と二次的なアウトカムとして,脳卒中,心筋梗塞,または血管死亡の複合体でした.
主要な成果:
- 再発性脳卒中率は,SBPグループによって異なっており,非常に高いSBPグループが最も高い割合 (14.1%) を示しています.
- 高正常SBP群 (130-<140 mm Hg) と比較すると,非常に低正常 (<120 mm Hg),高い (140-<150 mm Hg),および非常に高い (≥150 mm Hg) SBP群の患者は,再発性脳卒中のリスクが著しく高かった.
- 二次複合アウトカムのリスクの増加は,非常に低い正常値,低い正常値,高い,および非常に高いSBP群でも,高正常値群と比較して観察されました.
結論:
- 静脈動脈血圧のレベルが非常に低い (正常値<120mm Hg),高い (140-<150mm Hg),および非常に高い (≥150mm Hg) の範囲にあると,最近の非心臓栓塞性不全性脳卒中後に再発性脳卒中のリスクが増加することが関連しています.
- SBPを高正常範囲 (130-<140 mm Hg) の範囲で維持することは,再発性脳卒中および血管疾患のリスクを低下させる可能性があります.
- これらの発見は,SBPと脳卒中再発リスクの間の潜在的なJ形またはU形関係を示唆し,ターゲットSBPレベルに関する現在のガイドラインに挑戦しています.
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