Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
Stroke Vasc Neurol. 2022 Jun;7(3):237-244. doi: 10.1136/svn-2020-000718. Epub 2021 Nov 30.
The association between blood pressure variability (BPV) and stroke recurrence among patients who had ischaemic stroke (IS) remains unclear. This study aimed to investigate the association between BPV and stroke recurrence in patients who had IS of large artery atherosclerosis (LAA) subtype and small artery occlusion (SAO) subtype.
Data from the BOSS (Blood Pressure and Clinical Outcome in Transient Ischemic Attack or Ischemic Stroke) study were examined. IS subtypes were diagnosed according to the Trial of Org 10172 in Acute Stroke Treatment criteria. BPV was performed by 24-hour ambulatory blood pressure monitoring and defined through SD of blood pressure. The primary outcome was stroke recurrence within 90 days after discharge. Multivariable Cox regression model was used to assess the association between BPV and stroke recurrence in patients who had IS of LAA subtype and SAO subtype.
A total of 1390 patients who had IS from the BOSS study were included in the present study. Multivariable analysis suggests that 24-hour systolic BPV (SBPV) and night-time diastolic BPV (DBPV) were significantly associated with stroke recurrence among all patients who had IS (HR, 2.50, 95% CI 1.07 to 5.84; HR, 1.85, 95% CI 1.07 to 3.21, respectively). Night-time SBPV and night-time DBPV were significantly associated with stroke recurrence in patients with SAO subtype (HR, 2.77, 95% CI 1.07 to 7.15; HR, 3.60, 95% CI 1.39 to 9.29, respectively). However, in the adjusted model, only night-time DBPV remained significant in patients with SAO subtype (HR, 3.87, 95% CI 1.40 to 10.71). Similar results were not found in patients who had IS of LAA subtype.
High night-time DBPV was associated with increased risk of stroke recurrence among patients who had IS of SAO subtype. The results of this study have implications for the secondary prevention management and future research of patients who had IS of SAO subtype. The association between BPV and stroke recurrence in patients who had IS of LAA subtype and SAO subtype should be investigated in larger, population-based studies.
血压变异性（BPV）与缺血性卒中（IS）患者卒中复发之间的关系尚不清楚。本研究旨在探讨大动脉粥样硬化（LAA）亚型和小动脉闭塞（SAO）亚型 IS 患者的 BPV 与卒中复发之间的关系。
研究分析了 BOSS（短暂性脑缺血发作或缺血性卒中的血压和临床结局）研究的数据。根据试验性组织型纤溶酶原激活剂治疗急性卒中试验标准诊断 IS 亚型。通过 24 小时动态血压监测来评估 BPV，并通过血压标准差来定义。主要结局为出院后 90 天内卒中复发。采用多变量 Cox 回归模型评估 LAA 亚型和 SAO 亚型 IS 患者的 BPV 与卒中复发之间的关系。
本研究共纳入 1390 例来自 BOSS 研究的 IS 患者。多变量分析表明，24 小时收缩压 BPV（SBPV）和夜间舒张压 BPV（DBPV）与所有 IS 患者的卒中复发显著相关（HR，2.50；95%CI，1.07 至 5.84；HR，1.85；95%CI，1.07 至 3.21）。夜间 SBPV 和夜间 DBPV 与 SAO 亚型患者的卒中复发显著相关（HR，2.77；95%CI，1.07 至 7.15；HR，3.60；95%CI，1.39 至 9.29）。然而，在调整后的模型中，只有夜间 DBPV 在 SAO 亚型患者中仍然显著（HR，3.87；95%CI，1.40 至 10.71）。在 LAA 亚型患者中未发现类似结果。
夜间 DBPV 升高与 SAO 亚型 IS 患者卒中复发风险增加相关。本研究结果对 SAO 亚型 IS 患者的二级预防管理和未来研究具有启示意义。LAA 亚型和 SAO 亚型 IS 患者的 BPV 与卒中复发之间的关系应在更大的基于人群的研究中进行探讨。
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