Li Weijuan, Jin Cheng, Vaidya Anand, Wu Yuntao, Rexrode Kathryn, Zheng Xiaoming, Gurol Mahmut E, Ma Chaoran, Wu Shouling, Gao Xiang
From the Vanderbilt University Medical Center, Vanderbilt Heart and Vascular Institute, Nashville, TN (W.L.); Department of Cardiology, Kailuan General Hospital, Tangshan, People's Republic of China (C.J., Y.W., X.Z., S.W.); Department of Nutritional Sciences, Pennsylvania State University, State College (C.J., C.M., X.G.); Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (A.V.); Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA (K.R.); and Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston (M.E.G.).
Hypertension. 2017 Sep;70(3):508-514. doi: 10.1161/HYPERTENSIONAHA.117.09479. Epub 2017 Jul 17.
The association between long-term blood pressure (BP) patterns in community-dwelling adults and risk of intracerebral hemorrhage and cerebral infarction is not well characterized. This prospective study included 79 385 participants, free of stroke, myocardial infarction, and cancer in or before 2010 (baseline). Systolic BP trajectories were identified using latent mixture modeling with data from 2006, 2008, and 2010. Incident cases of intracerebral hemorrhage and cerebral infarction occurred during 2010 to 2014, confirmed by review of medical records, by 3 physicians. We identified 5 distinct systolic BP trajectories during 2006 to 2010. Each of the trajectories was labeled according to their BP range and pattern over time: normotensive-stable (n=26 740), prehypertension-stable (n=35 674), stage 1 hypertension-increasing (n=8215), stage 1 hypertension-decreasing (n=6422), and stage 2 hypertension-stable (n=2334). We documented 1034 incident cases of cerebral infarction and 187 cases of intracerebral hemorrhage. Although the prehypertension-stable trajectory exhibited systolic BP range within the normal range (120-140 mm Hg) during 2006 to 2010, this group had higher stroke risk relative to the normotensive-stable group (<120 mm Hg) (adjusted hazard ratio was 3.11 for intracerebral hemorrhage and 1.99 for cerebral infarction; <0.001 for both), after adjusting for possible confounders. Individuals in the stage 2 hypertension-stable systolic BP trajectory (175-179 mm Hg) had the highest risk of intracerebral hemorrhage (adjusted hazard ratio was 12.4) and cerebral infarction (adjusted hazard ratio was 5.07), relative to the normotensive-stable group (<0.001 for both). BP trajectories were associated with the risk of stroke and increasing BP trajectories within the currently designated normal range may still increase the risk for stroke.
社区居住成年人的长期血压模式与脑出血和脑梗死风险之间的关联尚未得到充分描述。这项前瞻性研究纳入了79385名在2010年（基线）及之前无中风、心肌梗死和癌症的参与者。利用2006年、2008年和2010年的数据，通过潜在混合模型确定收缩压轨迹。2010年至2014年期间发生的脑出血和脑梗死事件，经3名医生查阅病历确诊。我们在2006年至2010年期间确定了5种不同的收缩压轨迹。每种轨迹根据其血压范围和随时间的变化模式进行标记：正常血压稳定型（n = 26740）、高血压前期稳定型（n = 35674）、1级高血压上升型（n = 8215）、1级高血压下降型（n = 6422）和2级高血压稳定型（n = 2334）。我们记录了1034例脑梗死事件和187例脑出血事件。尽管高血压前期稳定型轨迹在2006年至2010年期间收缩压范围在正常范围内（120 - 140 mmHg），但在调整可能的混杂因素后，该组相对于正常血压稳定组（<120 mmHg）有更高的中风风险（脑出血的调整风险比为3.11，脑梗死为1.99；两者均<0.001）。相对于正常血压稳定组（两者均<0.001），2级高血压稳定型收缩压轨迹（175 - 179 mmHg）的个体发生脑出血（调整风险比为12.4）和脑梗死（调整风险比为5.07）的风险最高。血压轨迹与中风风险相关，当前指定正常范围内血压轨迹上升仍可能增加中风风险。
