Zhong Ping, Lu Zhiwen, Li Tianxiao, Lan Qing, Liu Jianmin, Wang Zhanxiang, Chen Sifang, Huang Qinghai
BE and Phase I Clinical Trial Center, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
Neurovascular Center, Changhai Hospital, Second Military Medical University, Changhai Road 168, Shanghai, 200433, China.
Transl Stroke Res. 2022 Dec;13(6):983-994. doi: 10.1007/s12975-022-01006-7. Epub 2022 Mar 21.
Although hypertension is a known risk factor for intracranial aneurysm rupture, the benefit of the management of blood pressure in reducing the rupture risk of intracranial aneurysms remains largely unknown, especially for regular blood pressure monitoring. We conducted a retrospective analysis of a prospectively maintained database of 3965 patients with saccular intracranial aneurysms from 20 medical centers in China. The patients were divided into the non-hypertensive group and hypertensive group. Propensity score matching was applied to identify a cohort of patients with similar baseline characteristics. Univariable and multivariable logistic regression analyses were performed to determine the association between intracranial aneurysm rupture and the management of blood pressure. After matching, hypertension was significantly associated with an increased rupture risk of intracranial aneurysms (OR = 2.559, 95%CI = 2.161-3.030, P = 0.000). For the management of blood pressure, controlled hypertension (OR = 1.803, 95%CI = 1.409-2.307, P = 0.000), uncontrolled hypertension (OR = 2.178, 95%CI = 1.756-2.700, P = 0.000), and hypertension without regular blood pressure monitoring (OR = 5.000, 95%CI = 3.823-6.540, P = 0.000) were all significantly associated with a higher rupture risk compared with the absence of hypertension. Moreover, hypertension without regular blood pressure monitoring was associated with a higher rupture risk compared with either controlled hypertension (OR = 3.807, 95%CI = 2.687-5.395, P = 0.000) or hypertension with regular blood pressure monitoring (including controlled and uncontrolled hypertension) (OR = 2.893, 95%CI = 2.319-3.609, P = 0.000). The absence of regular blood pressure monitoring was significantly associated with an increased risk of intracranial aneurysm rupture, emphasizing the importance of implementation of regular blood pressure monitoring in hypertensive patients with intracranial aneurysms.
尽管高血压是颅内动脉瘤破裂的已知危险因素，但血压管理在降低颅内动脉瘤破裂风险方面的益处仍大多未知，尤其是对于定期血压监测而言。我们对来自中国20个医疗中心的3965例囊状颅内动脉瘤患者的前瞻性维护数据库进行了回顾性分析。患者被分为非高血压组和高血压组。应用倾向得分匹配法来确定一组具有相似基线特征的患者。进行单变量和多变量逻辑回归分析以确定颅内动脉瘤破裂与血压管理之间的关联。匹配后，高血压与颅内动脉瘤破裂风险增加显著相关（OR = 2.559，95%CI = 2.161 - 3.030，P = 0.000）。对于血压管理，血压得到控制的高血压（OR = 1.803，95%CI = 1.409 - 2.307，P = 0.000）、血压未得到控制的高血压（OR = 2.178，95%CI = 1.756 - 2.700，P = 0.000）以及未进行定期血压监测的高血压（OR = 5.000，95%CI = 3.823 - 6.540，P = 0.000）与无高血压相比，均与更高的破裂风险显著相关。此外，与血压得到控制的高血压（OR = 3.807，95%CI = 2.687 - 5.395，P = 0.000）或进行定期血压监测的高血压（包括血压得到控制和未得到控制的高血压）（OR = 2.893，95%CI = 2.319 - 3.609，P = 0.000）相比，未进行定期血压监测的高血压与更高的破裂风险相关。未进行定期血压监测与颅内动脉瘤破裂风险增加显著相关，强调了对颅内动脉瘤高血压患者实施定期血压监测的重要性。
