Department of Neurology and Rehabilitation Medicine University of Cincinnati Cincinnati OH.
Department of Emergency Medicine University of Cincinnati Cincinnati OH.
J Am Heart Assoc. 2024 May 7;13(9):e032645. doi: 10.1161/JAHA.123.032645. Epub 2024 May 3.
Hypertension is a stroke risk factor with known disparities in prevalence and management between Black and White patients. We sought to identify if racial differences in presenting blood pressure (BP) during acute ischemic stroke exist.
Adults with acute ischemic stroke presenting to an emergency department within 24 hours of last known normal during study epochs 2005, 2010, and 2015 within the Greater Cincinnati/Northern Kentucky Stroke Study were included. Demographics, histories, arrival BP, National Institutes of Health Stroke Scale score, and time from last known normal were collected. Multivariable linear regression was used to determine differences in mean BP between Black and White patients, adjusting for age, sex, National Institutes of Health Stroke Scale score, history of hypertension, hyperlipidemia, smoking, stroke, body mass index, and study epoch. Of 4048 patients, 853 Black and 3195 White patients were included. In adjusted analysis, Black patients had higher presenting systolic BP (161 mm Hg [95% CI, 159-164] versus 158 mm Hg [95% CI, 157-159], <0.01), diastolic BP (86 mm Hg [95% CI, 85-88] versus 83 mm Hg [95% CI, 82-84], <0.01), and mean arterial pressure (111 mm Hg [95% CI, 110-113] versus 108 mm Hg [95% CI, 107-109], <0.01) compared with White patients. In adjusted subanalysis of patients <4.5 hours from last known normal, diastolic BP (88 mm Hg [95% CI, 86-90] versus 83 mm Hg [95% CI, 82-84], <0.01) and mean arterial pressure (112 mm Hg [95% CI, 110-114] versus 108 mm Hg [95% CI, 107-109], <0.01) were also higher in Black patients.
This population-based study suggests differences in presenting BP between Black and White patients during acute ischemic stroke. Further study is needed to determine whether these differences influence clinical decision-making, outcome, or clinical trial eligibility.
高血压是中风的一个危险因素，黑人和白人患者的患病率和管理水平存在已知差异。我们试图确定在急性缺血性中风患者中是否存在黑人与白人之间的血压差异。
在 2005 年、2010 年和 2015 年的大辛辛那提/北肯塔基州中风研究期间，纳入了在研究期间内发病 24 小时内最后一次正常时间就诊于急诊科的急性缺血性中风成年患者。收集了人口统计学资料、病史、入院时血压、美国国立卫生研究院中风量表评分和从最后一次正常时间的时间。采用多元线性回归来确定黑人与白人患者之间平均血压的差异，调整了年龄、性别、美国国立卫生研究院中风量表评分、高血压病史、高血脂、吸烟、中风、体重指数和研究时间。在 4048 名患者中，纳入了 853 名黑人患者和 3195 名白人患者。在调整分析中，黑人患者的收缩压更高（161mmHg[95%置信区间，159-164]比 158mmHg[95%置信区间，157-159]，<0.01），舒张压更高（86mmHg[95%置信区间，85-88]比 83mmHg[95%置信区间，82-84]，<0.01），平均动脉压更高（111mmHg[95%置信区间，110-113]比 108mmHg[95%置信区间，107-109]，<0.01）。在发病时间<4.5 小时的患者亚分析中，黑人患者的舒张压（88mmHg[95%置信区间，86-90]比 83mmHg[95%置信区间，82-84]，<0.01）和平均动脉压（112mmHg[95%置信区间，110-114]比 108mmHg[95%置信区间，107-109]，<0.01）也更高。
这项基于人群的研究表明，在急性缺血性中风患者中，黑人与白人患者的血压存在差异。需要进一步研究以确定这些差异是否会影响临床决策、结果或临床试验资格。
