Shim Hwan Seok, Park Jeong-Mee, Lee Yong Jae, Kim Young-Deok, Kim Tackeun, Ban Seung Pil, Bang Jae Seung, Kwon O-Ki, Oh Chang Wan, Lee Si Un
Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Republic of Korea.
Front Neurol. 2023 Oct 9;14:1268542. doi: 10.3389/fneur.2023.1268542. eCollection 2023.
There are few reports on the preventative value of intensive blood pressure (BP) management for stroke, especially hemorrhagic stroke (HS), after new criteria for hypertension (HTN) were announced by the American College of Cardiology/American Heart Association in 2017.
This study aimed to identify the optimal BP for the primary prevention of HS in a healthy population aged between 20 and 65 years.
We conducted a 10-year observational study on the risk of HS, subclassified as intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) according to BP categories (e.g., low normal BP, high normal BP, elevated BP, stage 1 HTN, and stage 2 HTN) using the National Health Insurance Service Database.
Out of 8,327,751 participants who underwent a health checkup in 2008, 949,550 were included in this study and observed from 2009 to 2018. The risk of ICH was significantly increased in men with stage 2 HTN {adjusted hazard ratio [aHR] 2.002 [95% confidence interval (CI) 1.203-3.332]} and in women with stage 1 HTN [aHR 2.021 (95% CI, 1.251-3.263)]. The risk of SAH was significantly increased in both men [aHR 1.637 (95% CI, 1.066-2.514)] and women [aHR 4.217 (95% CI, 2.648-6.715)] with stage 1 HTN. Additionally, the risk of HS was significantly increased in men with stage 2 HTN [aHR 3.034 (95% CI, 2.161-4.260)] and in women with stage 1 HTN [aHR 2.976 (95% CI, 2.222-3.986)].
To prevent primary HS, including ICH and SAH, BP management is recommended for adults under the age of 65 years with stage 1 HTN.
自美国心脏病学会/美国心脏协会于2017年公布高血压（HTN）新标准以来，关于强化血压（BP）管理对中风，尤其是出血性中风（HS）的预防价值的报道较少。
本研究旨在确定20至65岁健康人群中预防HS的最佳血压。
我们利用国民健康保险服务数据库，针对HS风险进行了一项为期10年的观察性研究，根据血压类别（如正常低限血压、正常高限血压、血压升高、1级HTN和2级HTN）将HS细分为脑出血（ICH）和蛛网膜下腔出血（SAH）。
在2008年接受健康检查的8327751名参与者中，949550名被纳入本研究，并于2009年至2018年进行观察。2级HTN男性发生ICH的风险显著增加{调整后风险比[aHR]2.002[95%置信区间（CI）1.203 - 3.332]}，1级HTN女性发生ICH的风险也显著增加[aHR 2.021（95%CI，1.251 - 3.263）]。1级HTN男性和女性发生SAH的风险均显著增加[男性aHR 1.637（95%CI，1.066 - 2.514）；女性aHR 4.217（95%CI，2.648 - 6.715）]。此外，2级HTN男性和1级HTN女性发生HS的风险均显著增加[男性aHR 3.034（95%CI，2.161 - 4.260）；女性aHR 2.976（95%CI，2.222 - 3.986）]。
为预防包括ICH和SAH在内的原发性HS，建议对65岁以下患有1级HTN的成年人进行血压管理。
