Oftedal Åshild, Gerdts Eva, Waje-Andreassen Ulrike, Fromm Annette, Naess Halvor, Linde Anja, Saeed Sahrai
a Department of Clinical Science , University of Bergen , Bergen , Norway.
b Department of Heart Disease , Haukeland University Hospital , Bergen , Norway.
Blood Press. 2018 Jun;27(3):173-180. doi: 10.1080/08037051.2018.1425827. Epub 2018 Jan 15.
Hypertension is the most important modifiable risk factor for stroke. Few data are available on control of hypertension in younger ischemic stroke survivors.
We assessed clinic and ambulatory blood pressure (BP) measurements in 320 patients aged 15-60 years (mean 48 ± 10) included in the Norwegian Stroke in the Young Study during 3-months follow-up after the index stroke. Controlled hypertension was defined as ambulatory BP <130/80 mmHg. Carotid-femoral pulse wave velocity (PWV) was measured by applanation tonometry. Carotid plaque was considered present if focal intima-media thickness >1.5 mm.
At hospital discharge, 58% of the patients were treated for hypertension. Another 9% of the total study population was diagnosed with new-onset hypertension during follow-up. At the 3-months follow-up visit, 56% of patients with treated hypertension were uncontrolled. Patients with uncontrolled treated hypertension were older, had higher body mass index (BMI) and PWV, and were more likely to have diabetes and carotid plaques compared to patients with normotension (p < .01). Compared to controlled treated hypertension, patients with uncontrolled treated hypertension had higher prevalence of carotid plaque (p < .01). In a multivariate logistic regression, uncontrolled treated hypertension was associated with higher PWV and BMI, and presence of carotid plaque, independent of the more intensified use of antihypertensive treatment (all p < .05).
Uncontrolled hypertension was highly prevalent in ischemic stroke survivors <60 years and associated with co-presence of obesity and functional and structural arterial damage. Our results highlight the unmet potential and challenge of optimization of hypertension diagnosis and management in order to prevent recurrent vascular events in ischemic stroke survivors.
高血压是卒中最重要的可改变风险因素。关于年轻缺血性卒中幸存者高血压控制情况的数据较少。
我们评估了纳入挪威青年卒中研究的320例年龄在15 - 60岁（平均48±10岁）患者在首次卒中后3个月随访期间的诊室血压和动态血压测量值。将血压得到控制定义为动态血压<130/80 mmHg。采用压平式眼压计测量颈股脉搏波速度（PWV）。若局部内膜中层厚度>1.5 mm，则认为存在颈动脉斑块。
出院时，58%的患者接受高血压治疗。在整个研究人群中，另有9%在随访期间被诊断为新发高血压。在3个月随访时，接受高血压治疗的患者中有56%血压未得到控制。与血压正常的患者相比，血压未得到控制的高血压患者年龄更大，体重指数（BMI）和PWV更高，更有可能患有糖尿病和颈动脉斑块（p<0.01）。与血压得到控制的高血压患者相比，血压未得到控制的高血压患者颈动脉斑块患病率更高（p<0.01）。在多因素逻辑回归分析中，血压未得到控制的高血压与较高的PWV和BMI以及颈动脉斑块的存在相关，与更强化的降压治疗使用无关（所有p<0.05）。
<60岁的缺血性卒中幸存者中，血压未得到控制的情况非常普遍，且与肥胖以及动脉功能和结构损伤同时存在有关。我们的结果凸显了在优化高血压诊断和管理以预防缺血性卒中幸存者复发性血管事件方面未满足的潜力和挑战。
