腔隙性短暂性脑缺血发作和卒中前血压控制的时间进程：基于人群的研究。
Time course of blood pressure control prior to lacunar TIA and stroke: Population-based study.
机构信息
From the Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience University of Oxford, UK.
出版信息
Neurology. 2018 May 15;90(20):e1732-e1741. doi: 10.1212/WNL.0000000000005526. Epub 2018 Apr 18.
OBJECTIVE
To determine the age-specific temporal trends in blood pressure (BP) before acute lacunar vs nonlacunar TIA and stroke.
METHODS
In a population-based study of TIA/ischemic stroke (Oxford Vascular Study), we studied 15-year premorbid BP readings from primary care records in patients with lacunar vs nonlacunar events (Trial of Org 10172 in Acute Stroke Treatment [TOAST]) stratified by age (<65, ≥65 years).
RESULTS
Of 2,085 patients (1,250 with stroke, 835 with TIA), 309 had lacunar events. In 493 patients <65 years of age, the prevalence of diagnosed hypertension did not differ between lacunar and nonlacunar events (46 [48.4%] vs 164 [41.2%], = 0.20), but mean/SD premorbid BP (44,496 BP readings) was higher in patients with lacunar events (15-year records: systolic BP [SBP] 138.5/17.7 vs 133.3/15.0 mm Hg, = 0.004; diastolic BP [DBP] 84.1/9.6 vs 80.9/8.4 mm Hg, = 0.001), mainly because of higher mean BP during the 5 years before the event (SBP 142.6/18.8 vs 134.6/16.6 mm Hg, = 0.0001; DBP 85.2/9.7 vs 80.6/9.0 mm Hg, < 0.0001), with a rising trend ( = 0.006) toward higher BP leading up to the event (<30-day pre-event SBP: 152.7/16.1 vs 135.3/23.1 mm Hg, = 0.009; DBP 87.9/9.4 vs 80.8/12.8 mm Hg, = 0.05; mean BP ≤1 year before the event 145.8/22.0 vs 134.7/16.1 mm Hg, = 0.001; 86.1/10.7 vs 80.4/9.8 mm Hg, = 0.0001). Maximum BP in the 5 years before the event was also higher in patients with lacunar events (SBP 173.7/26.6 vs 158.6/23.2 mm Hg, = 0.0001; DBP 102.3/12.9 vs 94.2/11.2 mm Hg, < 0.0001), as was persistently elevated BP (≥50% SBP >160 mm Hg, odd ratio 4.95, 95% confidence interval 1.99-12.31, = 0.0002). However, no similar differences in BP were observed in patients ≥65 years of age.
CONCLUSION
Recent premorbid BP control is strongly temporarily related to acute lacunar events at younger ages, suggesting a direct role of BP in accelerating causal pathology and highlighting the need to control hypertension quickly.
目的
确定急性腔隙性与非腔隙性 TIA 和卒中前血压（BP）的年龄特异性时间趋势。
方法
在 TIA/缺血性卒中（牛津血管研究）的基于人群的研究中，我们研究了分层按年龄（<65 岁，≥65 岁）的腔隙性与非腔隙性事件（组织 10172 急性卒中治疗试验 [TOAST]）患者的初级保健记录中 15 年的预发病史 BP 读数。
结果
在 2085 例患者（1250 例卒中，835 例 TIA）中，309 例发生腔隙性事件。在 493 例<65 岁的患者中，腔隙性与非腔隙性事件之间诊断为高血压的患病率无差异（46[48.4%]与 164[41.2%]，=0.20），但腔隙性事件患者的平均/SD 预发病史 BP（44496 次 BP 读数）更高（15 年记录：收缩压[SBP]138.5/17.7 与 133.3/15.0mmHg，=0.004；舒张压[DBP]84.1/9.6 与 80.9/8.4mmHg，=0.001），主要是因为事件前 5 年平均 BP 较高（SBP 142.6/18.8 与 134.6/16.6mmHg，=0.0001；DBP 85.2/9.7 与 80.6/9.0mmHg，<0.0001），并且随着时间的推移，BP 有升高的趋势（=0.006），导致事件前 BP 升高（<30 天的事件前 SBP：152.7/16.1 与 135.3/23.1mmHg，=0.009；DBP 87.9/9.4 与 80.8/12.8mmHg，=0.05；事件前 1 年的平均 BP 145.8/22.0 与 134.7/16.1mmHg，=0.001；86.1/10.7 与 80.4/9.8mmHg，=0.0001）。腔隙性事件患者在事件前 5 年的最大 BP 也更高（SBP 173.7/26.6 与 158.6/23.2mmHg，=0.0001；DBP 102.3/12.9 与 94.2/11.2mmHg，<0.0001），并且持续存在的 BP 升高（≥50%的 SBP>160mmHg，比值比 4.95，95%置信区间 1.99-12.31，=0.0002）。然而，在≥65 岁的患者中，没有观察到类似的 BP 差异。
结论
近期预发病史 BP 控制与年轻患者的急性腔隙性事件有强烈的时间相关性，提示 BP 直接作用于加速因果病理，并强调了快速控制高血压的必要性。
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