Center for Educational Research in Medical Sciences, Faculty of Medicine, Iran University of Medical Sciences, IUMS, Tehran, Iran.
Norwich Medical School, University of East Anglia, Norwich, UK.
BMC Cardiovasc Disord. 2022 Apr 9;22(1):161. doi: 10.1186/s12872-022-02600-1.
We aimed to compare the rate of stroke, transient ischemic attack, and cerebrovascular disease diagnoses across groups of patients based on their orthostatic blood pressure response in a transients ischemic attack clinic setting.
We retrospectively analysed prospectively collected data from 3201 patients referred to a transient ischemic attack (TIA)/minor stroke outpatients clinic. Trained nurses measured supine and standing blood pressure using an automated blood pressure device and the patients were categorized based on their orthostatic blood pressure change into four groups: no orthostatic blood pressure rise, systolic orthostatic hypertension, diastolic orthostatic hypertension, and combined orthostatic hypertension. Then, four stroke physicians, who were unaware of patients' orthostatic BP response, assessed the patients and made diagnoses based on clinical and imaging data. We compared the rate of stroke, TIA, and cerebrovascular disease (either stroke or TIA) diagnoses across the study groups using Pearson's χ test. The effect of confounders was adjusted using a multivariate logistic regression analysis.
Cerebrovascular disease was significantly less common in patients with combined systolic and diastolic orthostatic hypertension compared to the "no rise" group [OR = 0.56 (95% CI 0.35-0.89]. The odds were even lower among the subgroups of patients with obesity [OR = 0.31 (0.12-0.80)], without history of smoking [OR 0.34 (0.15-0.80)], and without hypertension [OR = 0.42 (95% CI 0.19-0.92)]. We found no significant relationship between orthostatic blood pressure rise with the diagnosis of stroke. However, the odds of TIA were significantly lower in patients with diastolic [OR 0.82 (0.68-0.98)] and combined types of orthostatic hypertension [OR = 0.54 (0.32-0.93)]; especially in patients younger than 65 years [OR = 0.17 (0.04-0.73)] without a history of hypertension [OR = 0.34 (0.13-0.91)], and patients who did not take antihypertensive therapy [OR = 0.35 (0.14-0.86)].
Our data suggest that orthostatic hypertension may be a protective factor for TIA among younger and normotensive patients.
我们旨在比较根据直立血压反应将患者分组后，在短暂性脑缺血发作（TIA）诊所中各组患者中风、短暂性脑缺血发作和脑血管疾病的诊断率。
我们回顾性分析了 3201 例转诊至 TIA/小中风门诊的患者前瞻性收集的数据。训练有素的护士使用自动血压装置测量仰卧位和站立位血压，根据直立血压变化将患者分为四组：无直立血压升高、收缩期直立性高血压、舒张期直立性高血压和联合直立性高血压。然后，四位不了解患者直立 BP 反应的卒中医生根据临床和影像学数据对患者进行评估并做出诊断。我们使用 Pearson χ 检验比较研究组之间中风、TIA 和脑血管疾病（中风或 TIA）的诊断率。使用多变量逻辑回归分析调整混杂因素的影响。
与“无升高”组相比，同时存在收缩期和舒张期直立性高血压的患者发生脑血管疾病的可能性明显较低[比值比（OR）=0.56（95%置信区间 0.35-0.89）]。在肥胖亚组[OR=0.31（0.12-0.80）]、无吸烟史亚组[OR=0.34（0.15-0.80）]和无高血压亚组[OR=0.42（95%置信区间 0.19-0.92）]中，这种可能性甚至更低。我们没有发现直立性血压升高与中风诊断之间存在显著关系。然而，在存在舒张期[OR=0.82（0.68-0.98）]和联合型直立性高血压[OR=0.54（0.32-0.93）]的患者中，TIA 的可能性显著降低；尤其是在年龄小于 65 岁的患者中[OR=0.17（0.04-0.73）]，无高血压病史[OR=0.34（0.13-0.91）]，且未服用降压药物的患者[OR=0.35（0.14-0.86）]。
我们的数据表明，直立性高血压可能是年轻且血压正常的 TIA 患者的保护因素。
