Yamamoto Yasumasa, Nagakane Yoshinari, Tomii Yasuhiro, Akiguchi Ichiro
Department of Neurology, Kyoto Katsura Hospital, Kyoto, Japan.
Department of Neurology, Kyoto Second Red Cross Hospital, Kyoto, Japan.
J Stroke Cerebrovasc Dis. 2016 Aug;25(8):1856-63. doi: 10.1016/j.jstrokecerebrovasdis.2016.04.001. Epub 2016 May 2.
Hypertension may be the most modifiable risk factor for post-stroke cognitive impairment (PSCI). We investigated how home blood pressure (HBP) can predict PSCI as well as stroke recurrence.
We studied 249 consecutive patients with noncardioembolic minor ischemic stroke including single lacunar infarct (sLI), multiple lacunae (mLI), and atherothrombotic infarction, which were tracked at our outpatient clinic. HBP was measured in the early morning (m-HBP) and just before going to bed (b-HBP). HBP categories based on systolic blood pressure were created as follows: HB1, both m-HBP and b-HBP less than 135 (mmHg); HB2, m-HBP less than or equal to135 and b-HBP less than 135; HB3, m-HBP less than 135 and b-HBP less than or equal to 135; HB4, both m-HBP and b-HBP less than or equal to 135. After 4.1 years of tracking, the patients were divided into 4 groups: Group 1, good outcome (n = 188); Group 2, the development of silent infarcts (n = 16); Group 3, the development of PSCI (n = 33); and Group 4, stroke recurrence (n = 15).
HB2 and HB4 (versus HB1) (hazard ratio [HR]: 6.5, P = .0068 and HR: 9.5, P = .0008, respectively) and mLI (versus sLI) (HR: 4.0, P = .021) were independently associated with Group 2. HB3 and HB4 (HR: 4.2, P = .037; HR: 5.4, P < .0001) and mLI (HR: 6.4, P < .0001) were significantly associated with Group 3. HB4 (HR: 8.1, P = .0002) and mLI (HR: 10.2, P = .0003) were significantly associated with Group 4. Clinic blood pressure (BP) was not significantly associated with any adverse groups.
High HBP and mLI were strongly associated with PSCI as well as stroke recurrence. BP should be monitored based on HBP, especially bedtime HBP, for the prevention of PSCI.
高血压可能是卒中后认知障碍（PSCI）最可改变的危险因素。我们研究了家庭血压（HBP）如何预测PSCI以及卒中复发。
我们研究了249例连续的非心源性轻度缺血性卒中患者，包括单发腔隙性梗死（sLI）、多发腔隙性梗死（mLI）和动脉粥样硬化性血栓形成性梗死，这些患者在我们的门诊进行随访。在清晨（m-HBP）和睡前（b-HBP）测量HBP。根据收缩压创建HBP类别如下：HB1，m-HBP和b-HBP均低于135（mmHg）；HB2，m-HBP小于或等于135且b-HBP低于135；HB3，m-HBP低于135且b-HBP小于或等于135；HB4，m-HBP和b-HBP均小于或等于135。经过4.1年的随访，患者被分为4组：第1组，预后良好（n = 188）；第2组，无症状性梗死的发生（n = 16）；第3组，PSCI的发生（n = 33）；第4组，卒中复发（n = 15）。
HB2和HB4（与HB1相比）（风险比[HR]：6.5，P = 0.0068和HR：9.5，P = 0.0008）以及mLI（与sLI相比）（HR：4.0，P = 0.021）与第2组独立相关。HB3和HB4（HR：4.2，P = 0.037；HR：5.4，P < 0.0001）以及mLI（HR：6.4，P < 0.0001）与第3组显著相关。HB4（HR：8.1，P = 0.0002）和mLI（HR：10.2，P = 0.0003）与第4组显著相关。诊室血压（BP）与任何不良组均无显著相关性。
高HBP和mLI与PSCI以及卒中复发密切相关。为预防PSCI，应基于HBP进行血压监测，尤其是睡前HBP。
