静脉血压在正常范围内的水平和复发性中风的风险
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
概括
在最近的缺血性中风后,保持非常低的缩血压 (SBP) 低于120 mm Hg或非常高的SBP高于150 mm Hg会增加再次中风的风险. 预防中风的最佳SBP似乎是在高正常范围 (130-140毫米升).
科学领域:
- 神经学 神经学
- 心脏病学 心脏病学
- 临床试验 临床试验
背景情况:
- 经常性中风预防指南主张显著降低缩血压 (SBP),将正常的SBP定义为小于120mmHg.
- 保持非常低的SBP对血管事件风险的后缺血性中风的影响仍然不清楚.
研究的目的:
- 调查不同系统血压 (SBP) 水平与最近非心血管栓塞性缺血性中风患者中复发性中风风险之间的关联.
主要方法:
- 一个多中心试验的后期观察分析,涉及20,330名近期缺血性中风患者 (年龄≥50岁).
- 患者被分为五个SBP组:非常低的正常 (<120毫米升),低的正常 (120-<130毫米升),高的正常 (130-<140毫米升),高的 (140-<150毫米升) 和非常高的 (≥150毫米升).
- 随访持续时间为2.5年,主要结局是复发性中风,次要结局是中风,心肌梗塞或血管死亡的复合.
主要成果:
- 在SBP组中,复发性中风的发生率各不相同,其中非常高的SBP组显示出最高的发生率 (14.1%).
- 与高正常SBP组 (130-<140毫米升) 相比,非常低正常 (<120毫米升),高 (140-<150毫米升) 和非常高 (≥150毫米升) SBP组的患者的复发中风风险明显更高.
- 与高正常组相比,在非常低的正常,低的正常,高的和非常高的SBP组中也观察到二次复合结果的风险增加.
结论:
- 在非常低的正常 (<120毫米升),高的 (140-<150毫米升) 和非常高的 (≥150毫米升) 范围内的静脉血压水平与最近非心血管血栓性缺血性中风后复发性中风的风险增加有关.
- 保持SBP在高正常范围内 (130-<140毫米升) 可能与复发性中风和血管事件的风险较低有关.
- 这些发现表明SBP和中风复发风险之间存在潜在的J形或U形关系,这挑战了目前关于目标SBP水平的指南.
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