Department of Cardiovascular Medicine, Research Center for Hypertension Management and Prevention in Community, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Am J Hypertens. 2024 Oct 14;37(11):893-900. doi: 10.1093/ajh/hpae095.
Mild asymptomatic intracranial atherosclerotic stenosis (aICAS) is common in Chinese patients with hypertension. However, there are no data on its prognostic value in this population. The aim of the present study was to clarify the prevalence and associated cardiovascular risk factors of mild aICAS and determine its prognostic value for overall and cardiovascular mortality in patients with hypertension.
In total, 1,813 participants were evaluated for aICAS using computed tomographic angiography. The predictive effect of mild to severe aICAS on all-cause and cardiovascular mortality was evaluated using Kaplan-Meier survival curves and Cox regression analyses.
The prevalence rate of mild aICAS was 35.7%. Poorly controlled hypertension, in combination with diabetes and dyslipidemia, was associated with aICAS. Patients with aICAS had an independently significant increase in the risk of all-cause and cardiovascular death, with adjusted hazard ratios (HRs) for mild to severe stenosis ranging from 1.56 to 3.30 for all-cause death and from 2.48 to 6.38 for cardiovascular death. Among the patients with mild aICAS, only those with more than two stenoses had increased mortality after adjustment, with an HR of 2.44 (95% CI: 1.42-4.18) for total death and 4.49 (95% CI: 1.82-11.05) for cardiovascular death.
A significant association between mild aICAS and mortality in stroke-free patients with hypertension was revealed. The results indicate that mild aICAS might be an imaging marker for cerebrovascular lesions in patients with hypertension and poor control of blood pressure and lipids in this population requires further research.
轻度无症状颅内动脉粥样硬化狭窄（aICAS）在中国高血压患者中较为常见。然而，目前尚缺乏该人群中轻度 aICAS 预后价值的数据。本研究旨在阐明轻度 aICAS 的患病率及其与心血管危险因素的相关性，并确定其在高血压患者全因和心血管死亡率方面的预后价值。
共对 1813 名患者使用计算机断层血管造影术评估 aICAS。采用 Kaplan-Meier 生存曲线和 Cox 回归分析评估轻度至重度 aICAS 对全因和心血管死亡率的预测作用。
轻度 aICAS 的患病率为 35.7%。控制不佳的高血压合并糖尿病和血脂异常与 aICAS 相关。患有 aICAS 的患者全因和心血管死亡的风险显著增加，轻度至重度狭窄的调整后危险比（HR）范围为 1.56 至 3.30 的全因死亡和 2.48 至 6.38 的心血管死亡。在轻度 aICAS 患者中，仅那些存在超过两个狭窄的患者在调整后死亡率增加，全因死亡的 HR 为 2.44（95%CI：1.42-4.18），心血管死亡的 HR 为 4.49（95%CI：1.82-11.05）。
本研究揭示了轻度 aICAS 与高血压无卒中患者死亡率之间存在显著相关性。结果表明，轻度 aICAS 可能是高血压患者脑血管病变的影像学标志物，该人群中血压和血脂控制不佳需要进一步研究。
