Lerario Michael P, Merkler Alexander E, Gialdini Gino, Parikh Neal S, Navi Babak B, Kamel Hooman
From the Department of Neurology (M.P.L., A.E.M., N.S.P., B.B.N., H.K.) and Feil Family Brain and Mind Research Institute (G.G., B.B.N., H.K.), Weill Cornell Medical College, New York, NY.
Stroke. 2016 Feb;47(2):372-5. doi: 10.1161/STROKEAHA.115.011992. Epub 2016 Jan 7.
Although chronic hypertension is a well-established risk factor for stroke, little is known about stroke risk after hypertensive encephalopathy (HE), when neurologic sequelae of hypertension become evident. Therefore, we evaluated the risk of stroke after a diagnosis of HE.
We identified all patients discharged from California, New York, and Florida emergency departments and acute care hospitals between 2005 and 2012 with a primary International Classification of Diseases, Ninth Edition, Clinical Modification discharge diagnosis of HE (437.2). Patients discharged with a primary diagnosis of seizure (345.x) served as negative controls, whereas patients with a primary diagnosis of transient ischemic attack (435.x) were positive controls. Our primary outcome was the composite of subsequent ischemic stroke or intracerebral hemorrhage. Kaplan-Meier survival statistics were used to calculate cumulative outcome rates, and Cox proportional hazard analysis was used to examine the association between index disease types and outcomes while adjusting for vascular risk factors.
We identified 8233 patients with HE, 191 091 with seizure, and 308 680 with transient ischemic attack. The 1-year cumulative rate of ischemic stroke or intracerebral hemorrhage after HE was 4.90% (95% confidence interval [CI], 4.45-5.40) when compared with 0.92% (95% CI, 0.88-0.97) after seizure and 4.49% (95% CI, 4.42-4.57) after transient ischemic attack. The risk of intracerebral hemorrhage was significantly elevated in those with HE (hazard ratio, 2.0; 95% CI, 1.7-2.5) but not in those with transient ischemic attack (hazard ratio, 1.0; 95% CI, 0.9-1.1), when compared with seizure patients.
Patients discharged with a diagnosis of HE face a high risk of future cerebrovascular events, particularly intracerebral hemorrhage.
虽然慢性高血压是公认的卒中危险因素，但对于高血压脑病（HE）后出现高血压神经系统后遗症时的卒中风险却知之甚少。因此，我们评估了诊断为HE后的卒中风险。
我们确定了2005年至2012年间从加利福尼亚州、纽约州和佛罗里达州的急诊科和急症护理医院出院的所有患者，其国际疾病分类第九版临床修订本的主要出院诊断为HE（437.2）。以原发性癫痫发作（345.x）为诊断出院的患者作为阴性对照，而以原发性短暂性脑缺血发作（435.x）为诊断的患者作为阳性对照。我们的主要结局是随后发生缺血性卒中或脑出血的复合情况。采用Kaplan-Meier生存统计来计算累积结局发生率，并采用Cox比例风险分析来检验索引疾病类型与结局之间的关联，同时对血管危险因素进行校正。
我们确定了8233例HE患者、191091例癫痫发作患者和308680例短暂性脑缺血发作患者。与癫痫发作后1年缺血性卒中或脑出血的累积发生率0.92%（95%置信区间[CI]，0.88 - 0.97）以及短暂性脑缺血发作后4.49%（95%CI，4.42 - 4.57）相比，HE后1年缺血性卒中或脑出血的累积发生率为4.90%（95%CI，4.45 - 5.40）。与癫痫发作患者相比，HE患者脑出血风险显著升高（风险比，2.0；95%CI，1.7 - 2.5），而短暂性脑缺血发作患者则未升高（风险比，1.0；95%CI，0.9 - 1.1）。
诊断为HE出院的患者面临未来脑血管事件的高风险，尤其是脑出血。
