Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University, Seongnam.
Clinical Research Center, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea.
J Hypertens. 2019 Oct;37(10):2000-2006. doi: 10.1097/HJH.0000000000002126.
We aimed to investigate whether blood pressure (BP) in the subacute stage of ischemic stroke affects subsequent vascular events after acute ischemic stroke.
From a prospective stroke registry database, consecutive ischemic stroke patients arriving within 48 h of onset were identified. The mean and SD of SBP per patient (SBPmean and SBPSD) in the subacute stage (from 72 h of onset to discharge), were calculated. Primary outcome was a composite of stroke, myocardial infarction and vascular death that occurred within 1 year after hospital discharge. A Cox proportional hazards model was applied to elucidate whether the increase of SBPmean and SBPSD would increase the hazards of the primary outcome.
Of 4415 patients (age, 66.7 ± 13.2 years; men, 69.5%), mean ± SD of SBPmean and SBPSD in the subacute stage was 137.3 ± 15.4 and 13.3 ± 3.9 mmHg, respectively. Primary outcome events occurred in 6.9% during the first year after stroke. There was a significant dose-response relationship between the SBPSD and the risk of the primary outcome (P = 0.004), but not between SBPmean and the risk (P = 0.78). Interpolating the change of adjusted hazard ratio using restricted cubic spine function suggested an existence of a threshold effect of SBPSD and a U-shaped relationship of SBPmean for the composite event.
This study shows that BP variability but not mean BP in the subacute stage of ischemic stroke may increase 1-year risk of major vascular events in patients surviving its acute stage.
本研究旨在探讨缺血性脑卒中亚急性期血压（BP）是否会影响急性缺血性脑卒中后血管事件的发生。
从前瞻性脑卒中登记数据库中，确定发病后 48 小时内到达的连续缺血性脑卒中患者。计算亚急性期（发病后 72 小时至出院）每位患者的 SBP 均值（SBPmean）和标准差（SBPSD）。主要终点为卒中、心肌梗死和血管性死亡的复合终点，发生于出院后 1 年内。采用 Cox 比例风险模型阐明 SBPmean 和 SBPSD 的增加是否会增加主要终点的风险。
在 4415 例患者（年龄 66.7±13.2 岁，男性 69.5%）中，亚急性期的 SBPmean 和 SBPSD 分别为 137.3±15.4mmHg 和 13.3±3.9mmHg。卒中后第一年主要终点事件发生率为 6.9%。SBPSD 与主要终点风险呈显著剂量反应关系（P=0.004），而 SBPmean 与风险无显著相关性（P=0.78）。采用限制三次样条函数对校正后危险比的变化进行插值表明，SBPSD 存在阈值效应，而 SBPmean 与复合事件呈 U 型关系。
本研究表明，缺血性脑卒中亚急性期的 BP 变异性而非平均 BP 可能会增加急性脑卒中后患者 1 年主要血管事件的风险。
