From the Department of Neurology (W.J.P.), University of North Carolina School of Medicine, Chapel Hill; Clinical Trials Statistics and Data Management Center (W.R.C.), University of Iowa College of Public Health, Iowa City; Departments of Neurological Surgery (R.L.G., C.P.D.), Radiology (R.L.G., T.O.V., C.P.D.), and Neurology (T.O.V., C.P.D.), Washington University School of Medicine, St. Louis, MO; and the Department of Neurology (H.P.A.), University of Iowa Carver School of Medicine, Iowa City.
Neurology. 2014 Mar 25;82(12):1027-32. doi: 10.1212/WNL.0000000000000238. Epub 2014 Feb 14.
To determine whether strict blood pressure (BP) control is the best medical management for patients with symptomatic carotid artery occlusion and hemodynamic cerebral ischemia.
In this prospective observational cohort study, we analyzed data from 91 participants in the nonsurgical group of the Carotid Occlusion Surgery Study (COSS) who had recent symptomatic internal carotid artery occlusion and hemodynamic cerebral ischemia manifested by ipsilateral increased oxygen extraction fraction. The target BP goal in COSS was ≤130/85 mm Hg. We compared the occurrence of ipsilateral ischemic stroke during follow-up in the 41 participants with mean BP ≤130/85 mm Hg to the remaining 50 with higher BP.
Of 16 total ipsilateral ischemic strokes that occurred during follow-up, 3 occurred in the 41 participants with mean follow-up BP of ≤130/85 mm Hg, compared to 13 in the remaining 50 participants with mean follow-up BP >130/85 mm Hg (hazard ratio 3.742, 95% confidence interval 1.065-13.152, log-rank p = 0.027).
BPs ≤130/85 mm Hg were associated with lower subsequent stroke risk in these patients.
This study provides Class III evidence that control of hypertension ≤130/85 mm Hg is associated with a reduced risk of subsequent ipsilateral ischemic stroke in patients with recently symptomatic carotid occlusion and hemodynamic cerebral ischemia (increased oxygen extraction fraction).
确定严格的血压（BP）控制是否是症状性颈动脉闭塞和血液动力学性脑缺血患者的最佳医学治疗方法。
在这项前瞻性观察性队列研究中，我们分析了 Carotid Occlusion Surgery Study（COSS）非手术组中 91 名近期出现症状性颈内动脉闭塞和血液动力学性脑缺血的患者的数据，这些患者表现为同侧氧摄取分数增加。COSS 的目标血压目标为≤130/85mmHg。我们比较了随访期间平均血压≤130/85mmHg 的 41 名参与者和血压较高的其余 50 名参与者同侧缺血性卒中的发生情况。
在随访期间共发生了 16 例总同侧缺血性卒中，其中 3 例发生在平均随访血压≤130/85mmHg 的 41 名参与者中，而在其余 50 名平均随访血压>130/85mmHg 的参与者中发生了 13 例（风险比 3.742，95%置信区间 1.065-13.152，对数秩检验 p = 0.027）。
这些患者的 BP≤130/85mmHg 与随后发生的卒中风险降低相关。
这项研究提供了 III 级证据，表明控制高血压≤130/85mmHg 与近期出现症状性颈动脉闭塞和血液动力学性脑缺血（氧摄取分数增加）的患者随后同侧缺血性卒中风险降低相关。
