Liu Chi-Hung, Lin Yu-Sheng, Chi Ching-Chi, Liou Chia-Wei, Lee Jiann-Der, Peng Tsung-I, Lee Tsong-Hai
Stroke Center and Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Ther Adv Neurol Disord. 2018 Sep 28;11:1756286418802688. doi: 10.1177/1756286418802688. eCollection 2018.
To compare the long-term clinical outcomes of different antihypertensive drugs in stable patients after acute hemorrhagic stroke (HS).
From January 2001 to December 2013, patients with first-ever primary HS were identified in the National Health Insurance Research Database, Taiwan. Patients with traumatic intracerebral hemorrhage and secondary HS were excluded. Those with first-ever HS were recruited and classified into three groups: (1) angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB); (2) calcium channel blocker (CCB); and (3) other antihypertensive drugs (comparison) groups. Propensity score matching was used to balance the distribution of baseline characteristics, stroke severity, and medications between any two of the three groups. A validation study was performed using the databank of the Stroke Registry in Chang-Gung Healthcare System to reduce the bias. Primary outcomes were recurrent HS, ischemic stroke, any stroke, and all-cause mortality.
Compared to the comparison group, the ACEI/ARB group [35.4% 39.3%; hazard ratio (HR), 0.84; 95% confidence interval (CI), 0.74-0.95] and CCB group (33.0% 41.9%; HR, 0.72; 95% CI, 0.64-0.81) had a lower risk of all-cause mortality during long-term follow up. The CCB group had a similar risk of all-cause mortality to the ACEI/ARB group. Risks of recurrent HS, ischemic stroke, or any stroke were not different between the study groups.
Antihypertensive drug class could be important to long-term outcomes in HS patients in addition to the target control of blood pressure. Both ACEIs/ARBs and CCBs are associated with lower risks of all-cause mortality. Our results may be applied to inform future research on hypertensive control in HS patients.
比较急性出血性卒中（HS）后病情稳定患者使用不同降压药物的长期临床结局。
2001年1月至2013年12月，在台湾国民健康保险研究数据库中识别首次发生原发性HS的患者。排除创伤性脑出血和继发性HS患者。招募首次发生HS的患者并分为三组：（1）血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ACEI/ARB）组；（2）钙通道阻滞剂（CCB）组；（3）其他降压药物（对照）组。采用倾向评分匹配法平衡三组中任意两组之间的基线特征、卒中严重程度和用药分布。利用长庚医疗系统卒中登记数据库进行验证研究以减少偏差。主要结局为复发性HS、缺血性卒中、任何卒中及全因死亡率。
与对照组相比，ACEI/ARB组[35.4% 39.3%；风险比（HR），0.84；95%置信区间（CI），0.74 - 0.95]和CCB组（33.0% 41.9%；HR，0.72；95% CI，0.64 - 0.81）在长期随访期间全因死亡率风险较低。CCB组与ACEI/ARB组的全因死亡率风险相似。各研究组之间复发性HS、缺血性卒中或任何卒中的风险无差异。
除血压目标控制外，降压药物类别对HS患者的长期结局可能很重要。ACEI/ARB和CCB均与较低的全因死亡率风险相关。我们的结果可用于为未来HS患者高血压控制的研究提供参考。
