Tao Y, Xu J, Song B, Xie X, Gu H, Liu Q, Zhao L, Wang Y, Xu Y, Wang Y
Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Henan, China.
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
J Hum Hypertens. 2017 Sep;31(9):568-573. doi: 10.1038/jhh.2017.32. Epub 2017 Apr 27.
The relationship between blood pressure variability (BPV) and stroke recurrence is controversial. This study aimed to evaluate the predictive value of short-term and long-term BPV for stroke recurrence. The data from blood pressure and clinical outcome in TIA or ischemic stroke (BOSS) study included participants with acute ischemic stroke or transient ischemic attack (TIA) within 7 days after onset. Short-term BPV was measured by 24-h ambulatory BP measurement during hospitalisation. Long-term BPV, based on home blood pressure measurement, was measured by patients or their families from discharge to 90 days after qualifying events onset (twice daily). Variability for systolic blood pressure (SBP) was assessed as the s.d., coefficients of variance (CV). The clinical outcome was recurrent stroke within 1 year. Cox proportional hazards models were used to test the association of short-term BPV, long-term BPV and stroke recurrence. Among 1764 participants, the mean age was 62.45±10.99 years, and 32.1% were females, during 1-year follow-up, 106 (6.0%) participants experienced recurrent stroke. Indices of long-term BPV were significantly associated with stroke recurrence (s.d.: adjusted HR: 1.939, 95% CI: 1.122-3.351; CV: adjusted HR 1.955, 95% CI: 1.174-3.255), independent of mean SBP. However, all indices of short-term BPV (s.d., CV) were not associated with stroke recurrence (s.d.: adjusted HR: 1.245, 95% CI: 0.680-2.280; CV: adjusted HR: 1.142, 95% CI: 0.640-2.038). In conclusion, long-term variation of SBP is a better predictor than short-term variation of SBP for recurrent stroke after acute ischemic stroke or TIA.
血压变异性（BPV）与卒中复发之间的关系存在争议。本研究旨在评估短期和长期BPV对卒中复发的预测价值。短暂性脑缺血发作或缺血性卒中（BOSS）研究中的血压和临床结局数据纳入了发病后7天内的急性缺血性卒中或短暂性脑缺血发作（TIA）患者。短期BPV通过住院期间的24小时动态血压测量来测定。长期BPV基于家庭血压测量，由患者或其家属在符合条件事件发作后出院至90天期间测量（每日两次）。收缩压（SBP）变异性通过标准差、变异系数（CV）进行评估。临床结局为1年内复发性卒中。采用Cox比例风险模型来检验短期BPV、长期BPV与卒中复发之间的关联。在1764名参与者中，平均年龄为62.45±10.99岁，女性占32.1%，在1年的随访期间，106名（6.0%）参与者发生了复发性卒中。长期BPV指标与卒中复发显著相关（标准差：校正后风险比：1.939，95%置信区间：1.122 - 3.351；CV：校正后风险比1.955，95%置信区间：1.174 - 3.255），独立于平均SBP。然而，短期BPV的所有指标（标准差、CV）均与卒中复发无关（标准差：校正后风险比：1.245，95%置信区间：0.680 - 2.280；CV：校正后风险比：1.142，95%置信区间：0.640 - 2.038）。总之，对于急性缺血性卒中或TIA后的复发性卒中，SBP的长期变异比短期变异是更好的预测指标。
