Department of Neurology, Seonam University Myongji Hospital, Goyang, South Korea.
Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
Eur J Neurol. 2017 Nov;24(11):1416-1423. doi: 10.1111/ene.13411. Epub 2017 Sep 22.
Recent clinical trials and expert consensus guidelines have typically focused on the issue of systolic blood pressure (SBP) targets for reducing vascular risk. However, little is known about the relationship of the diastolic BP (DBP) level with vascular outcomes after a stroke.
A multicenter trial dataset involving 3680 recent (<4 months) non-cardioembolic stroke patients followed for 2 years was analyzed. Subjects were categorized per mean DBP level (mmHg) during follow-up: low-normal (<70), normal (70 to <80), high-normal (80-89) and high (≥90). Pulse pressure (PP) was prespecified by three categories of <60, 60 to <70, and ≥70 mmHg. Independent associations of mean DBP level with major vascular events (MVEs) and ischaemic stroke were assessed.
Major vascular events occurred in 20.7% of the low-normal, 15.1% of the normal, 16.9% of the high-normal and 19.2% of the high DBP groups, whilst stroke occurred in 9.9%, 6.8%, 8.5% and 10.8%, respectively. Compared with the normal DBP group, risk of MVEs was higher in the low-normal DBP group (adjusted hazard ratio 1.33; 95% confidence interval 1.04-1.71). Amongst those with SBP 120 to <140 mmHg, risk of MVEs (1.89; 1.13-3.15) and stroke (2.87; 1.48-5.53) was higher in subjects with PP ≥70 (mean DBP 62.4 ± 3.8) than those with the lowest PP (mean DBP 78.0 ± 5.9) whilst, amongst those with SBP <120 mmHg, PP 60 to <70 (mean DBP 52.7 ± 2.5) was associated with increased risk of stroke (5.85; 1.25-27.5).
Diastolic BP levels in the low-normal range, particularly accompanied by an increased PP of >60, confer increased risk of MVEs and stroke amongst patients after recent non-cardioembolic stroke.
最近的临床试验和专家共识指南通常侧重于降低血管风险的收缩压（SBP）目标问题。然而，对于中风后舒张压（DBP）水平与血管结局的关系知之甚少。
对一项涉及 3680 例近期（<4 个月）非心源性中风患者的多中心试验数据集进行了分析。根据随访期间的平均 DBP 水平（mmHg）将受试者分类：正常低限（<70）、正常（70-<80）、正常高限（80-89）和高限（≥90）。预设了三个类别<60、60-<70 和≥70mmHg 的脉搏压（PP）。评估平均 DBP 水平与主要血管事件（MVEs）和缺血性中风的独立关联。
低正常 DBP 组、正常 DBP 组、正常高限 DBP 组和高限 DBP 组的主要血管事件发生率分别为 20.7%、15.1%、16.9%和 19.2%，中风发生率分别为 9.9%、6.8%、8.5%和 10.8%。与正常 DBP 组相比，低正常 DBP 组的 MVEs 风险更高（调整后的危险比为 1.33；95%置信区间为 1.04-1.71）。在 SBP 为 120-<140mmHg 的患者中，PP≥70（平均 DBP 为 62.4±3.8）的患者发生 MVEs（1.89；1.13-3.15）和中风（2.87；1.48-5.53）的风险高于 PP 最低的患者（平均 DBP 为 78.0±5.9），而 SBP<120mmHg 的患者中，PP 为 60-<70（平均 DBP 为 52.7±2.5）与中风风险增加相关（5.85；1.25-27.5）。
近期非心源性中风后，正常低限范围的舒张压水平，特别是伴有>60mmHg 的脉压增加，会增加 MVEs 和中风的风险。
