Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
Sci Rep. 2017 Oct 25;7(1):14023. doi: 10.1038/s41598-017-10887-w.
We aimed to assess the association between systolic blood pressure (SBP) and clinical outcome in 2,397 ischemic stroke (IS) or transient ischemic attack (TIA) patients from the Blood Pressure and Clinical Outcome in TIA or Ischemic Stroke (BOSS) study. BOSS study was a hospital-based, prospective cohort study. The SBP was defined as mean value of 90 days self-measured SBP after onset. Cox proportional hazards models were conducted to test the risk of combined vascular events (CVE) and stroke recurrence among different SBP categories. Restricted cubic splines were used to explore the shape of associations between SBP and clinical outcomes. A J-shaped association of SBP with CVE and stroke recurrence within 90 days was observed (P nonlinearity < 0.001 for both). After adjusting for age, gender, medical history, atrial fibrillation, admission NHISS score, and secondary prevention. The hazard ratios (95% confidence intervals) of SBP <115 and ⩾165 mmHg compared with 125-134 mmHg were 3.45 (1.11-10.66) and 7.20 (2.91-17.80) for CVE, 2.68 (0.75-9.53) and 9.69 (3.86-24.35) for stroke recurrence, respectively. Similar J-shaped relationships were found after 1 year of follow-up. In conclusion, both high and low SBP are associated with poor prognosis in this population.
我们旨在评估 2397 例缺血性脑卒中（IS）或短暂性脑缺血发作（TIA）患者的收缩压（SBP）与临床结局之间的关系，这些患者来自于血压与 TIA 或缺血性脑卒中的临床结局（BOSS）研究。BOSS 研究是一项基于医院的前瞻性队列研究。SBP 定义为发病后 90 天自我测量 SBP 的平均值。采用 Cox 比例风险模型检验不同 SBP 类别中复合血管事件（CVE）和卒中复发的风险。采用限制性三次样条探索 SBP 与临床结局之间的关联形状。观察到 SBP 与 90 天内 CVE 和卒中复发之间呈 J 型关联（两者的非线性 P<0.001）。在校正年龄、性别、病史、房颤、入院 NHISS 评分和二级预防后，SBP<115mmHg 和 ⩾165mmHg 与 125-134mmHg 相比，CVE 的风险比（95%置信区间）分别为 3.45（1.11-10.66）和 7.20（2.91-17.80），卒中复发的风险比分别为 2.68（0.75-9.53）和 9.69（3.86-24.35）。在随访 1 年后也发现了类似的 J 型关系。总之，在该人群中，高 SBP 和低 SBP 均与不良预后相关。
