Xu Jie, Jiang Fei, Wang Anxin, Zhi Hui, Gao Yuan, Tian Junping, Mo Jinglin, Chen Zimo, Xu An-Ding, Luo Benyan, Hu Bo, Zhang Yuqing, Zhao Xingquan, Wang Yilong, Li Hao, Shen Haipeng, Wang Yongjun
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases (NCRCND), Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Stroke Vasc Neurol. 2021 Sep;6(3):352-358. doi: 10.1136/svn-2020-000526. Epub 2021 Jan 19.
To establish a new ambulatory blood pressure (ABP) parameter (24-hour ABP profile) and evaluated its performance on stroke outcome in ischaemic stroke (IS) or transient ischaemic attack (TIA) patients.
The prospective cohort consisted of 1996 IS/TIA patients enrolled for ABP monitoring and a 3-month follow-up for stroke recurrence as outcome. Profile groups of systolic blood pressure (SBP) were identified via an advanced functional clustering method, and the associations of the profile groups and conventional ABP parameters with stroke recurrence were examined in a Cox proportional hazards model.
Three discrete profile groups (n=604, 781 and 611 in profiles 1, 2 and 3, respectively) in 24-hour ambulatory SBP were identified. Profile 1 resembled most to the normal diurnal blood pressure pattern; profile 2 also dropped at night, but climbed earlier and with higher morning surge; while profile 3 had sustained higher nocturnal SBP without significant nocturnal SBP decline. The incidence of stroke recurrence was 2.9%, 3.9% and 5.5% in profiles 1, 2 and 3, respectively. After adjustment for covariates, profile 3 was significantly associated with higher risk of stroke recurrence with profile 1 as reference (HR 1.76, 95% CI: 1.00 to 3.09), while no significant difference was observed between profiles 2 and 1 (HR 1.22, 95% CI: 0.66 to 2.25). None of conventional ABP parameters showed significant associations with the outcome.
Ambulatory 24-hour SBP profile is associated with short-term stroke recurrence. Profiles of ABP may help improve identification of stroke recurrence by capturing the additive effects of individual ABP parameters.
建立一种新的动态血压（ABP）参数（24小时ABP曲线），并评估其对缺血性卒中（IS）或短暂性脑缺血发作（TIA）患者卒中结局的预测性能。
前瞻性队列研究纳入了1996例接受ABP监测的IS/TIA患者，并以卒中复发作为结局进行了3个月的随访。通过先进的功能聚类方法确定收缩压（SBP）曲线组，并在Cox比例风险模型中检验曲线组和传统ABP参数与卒中复发的关联。
在24小时动态SBP中识别出三个离散的曲线组（分别在曲线1、2和3中有604例、781例和611例）。曲线1最接近正常的昼夜血压模式；曲线2夜间血压也下降，但上升较早且早晨血压激增较高；而曲线3夜间SBP持续较高，夜间SBP无明显下降。曲线1、2和3中卒中复发的发生率分别为2.9%、3.9%和5.5%。在对协变量进行调整后，以曲线1为参照，曲线3与卒中复发风险较高显著相关（HR 1.76，95%CI：1.00至3.09），而曲线2和曲线1之间未观察到显著差异（HR 1.22，95%CI：0.66至2.25）。传统ABP参数均未显示与结局有显著关联。
24小时动态SBP曲线与短期卒中复发相关。ABP曲线可能通过捕捉个体ABP参数的累加效应，有助于改善对卒中复发的识别。
