Department of Neurology, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan.
Department of Prevented Medicine and Public Health, Faculty of Medicine, Fukuoka University, Jonan, Fukuoka, Japan.
Hypertens Res. 2022 Apr;45(4):591-601. doi: 10.1038/s41440-022-00862-y. Epub 2022 Mar 4.
The Recurrent Stroke Prevention Clinical Outcome (RESPECT) Study and its pooled analysis showed that intensive blood pressure (BP) lowering reduced recurrent stroke risk by 22% in patients with a history of stroke. Here, we report the effect of intensive BP lowering on the risk of recurrent stroke subtypes in patients with a history of ischemic stroke. RESPECT was a randomized clinical trial among 1280 people with a history of cerebral infarction or intracerebral hemorrhage. Participants were assigned to the intensive blood pressure control group (blood pressure < 120/80 mmHg) or standard blood pressure control group (blood pressure < 140/90 mmHg). In this post hoc analysis, we analyzed 1074 patients with a history of cerebral infarction. The mean BP at baseline was 140.7/81.4 mmHg. Throughout the follow-up period, the mean BP was 133.4/77.5 (95% CI, 132.7-134.1/76.9-78.2) mmHg in the standard group and 126.7/74.1 (95% CI, 126.0-127.4/73.5-74.8) mmHg in the intensive group. During a mean follow-up of 3.9 years, 78 first recurrent strokes occurred. Intensive treatment tended to reduce overall annual stroke recurrence (1.74% in intensive vs. 2.17% in standard; P = 0.351 by log-rank test) and did not change the risk of ischemic stroke (1.74% vs. 1.75%, P = 0.999) but markedly reduced the risk of hemorrhagic stroke (0.00% vs. 0.39%, P = 0.005). Beneficial effects of intensive BP control were observed for the risk of hemorrhagic stroke in patients with a history of ischemic stroke. The findings of this study indicate the benefit of intensive BP control for patients with a history of ischemic stroke at high risk of hemorrhagic stroke.
《复发性卒中预防临床结局（RESPECT）研究》及其荟萃分析显示，在有卒中病史的患者中，强化降压可使卒中复发风险降低 22%。在这里，我们报告强化降压对有缺血性卒中病史患者的卒中亚型复发风险的影响。RESPECT 是一项针对 1280 名有脑梗死或脑出血病史的患者进行的随机临床试验。参与者被分配到强化血压控制组（血压<120/80mmHg）或标准血压控制组（血压<140/90mmHg）。在这项事后分析中，我们分析了 1074 名有脑梗死病史的患者。基线时的平均血压为 140.7/81.4mmHg。在整个随访期间，标准组的平均血压为 133.4/77.5mmHg（95%CI，132.7-134.1/76.9-78.2），强化组为 126.7/74.1mmHg（95%CI，126.0-127.4/73.5-74.8）。在平均 3.9 年的随访期间，78 例首次复发卒中。强化治疗倾向于降低总体年度卒中复发率（强化组为 1.74%，标准组为 2.17%；对数秩检验 P=0.351），且不改变缺血性卒中的风险（1.74% vs. 1.75%，P=0.999），但显著降低出血性卒中的风险（0.00% vs. 0.39%，P=0.005）。强化血压控制对有缺血性卒中病史且出血性卒中风险较高的患者的出血性卒中风险具有有益影响。本研究的结果表明，强化血压控制对有缺血性卒中病史且有较高出血性卒中风险的患者有益。
