Department of Neurology University of Tennessee Health Science Center Memphis Tennessee.
Department of Preventive Medicine College of Medicine University of Tennessee Health Science Center Memphis Tennessee.
Ann Clin Transl Neurol. 2018 Nov 28;6(1):144-153. doi: 10.1002/acn3.693. eCollection 2019 Jan.
Traditional neurology teaching states that when mean arterial pressure dips below a 60 mm Hg threshold, there is an increase in stroke risk due to cerebral hypoperfusion. The aim of this study was to determine whether intensive lowering of systolic blood pressure increases adverse cardiovascular outcomes by examining the association between achieved blood pressure values, specifically mean arterial pressure and pulse pressure, and risk of stroke.
Data from participants in the Systolic Blood Pressure Intervention Trial (SPRINT) and the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Blood Pressure (BP) trial were examined, using survival analysis to model minimal arterial pressure and average pulse pressure during the study period against risk of stroke, hypotension, and syncope, with death as a competing risk.
In both SPRINT and ACCORD participants, there was no increase in stroke risk with achieved mean arterial pressure values below 60 mm Hg. In SPRINT participants, achieved mean arterial pressure values greater than 90 mm Hg were associated with a 247% (HR: 3.47, 95% CI: 2.06-5.85) higher risk of stroke compared with participants in the 80-89 mmHg reference group. No association was found between low achieved pulse pressure values and greater stroke risk in either the SPRINT or ACCORD participants, as well as no association between mean arterial pressure and pulse pressure values and risk of syncope.
Intensive lowering of systolic blood pressure does not increase risk of stroke in hypertensive patients, despite extremely low mean arterial pressure or pulse pressure values.
传统神经病学教学认为，当平均动脉压降至 60mmHg 以下时，由于脑灌注不足，中风风险会增加。本研究旨在通过检查达到的血压值（特别是平均动脉压和脉压）与中风风险之间的关系，确定收缩压的强化降低是否会通过增加不良心血管结局来增加中风风险。
对 Systolic Blood Pressure Intervention Trial（SPRINT）和 Action to Control Cardiovascular Risk in Diabetes（ACCORD）Blood Pressure（BP）试验的参与者数据进行了检查，使用生存分析来模拟研究期间的最小动脉压和平均脉压与中风、低血压和晕厥风险之间的关系，死亡是竞争风险。
在 SPRINT 和 ACCORD 参与者中，达到的平均动脉压值低于 60mmHg 并不会增加中风风险。在 SPRINT 参与者中，与 80-89mmHg 参考组相比，达到的平均动脉压值大于 90mmHg 与中风风险增加 247%（HR：3.47，95%CI：2.06-5.85）相关。在 SPRINT 或 ACCORD 参与者中，达到的低脉压值与更高的中风风险之间没有关联，平均动脉压和脉压值与晕厥风险之间也没有关联。
尽管平均动脉压或脉压值极低，但强化降低收缩压不会增加高血压患者的中风风险。
