Huang Huifen, Zhan Yanli, Yu Linling, Li Shan, Cai Xueli
Neurology Department of Lishui Municipal Central Hospital, 323000 Lishui, Zhejiang, China.
Lishui Cardio-Cerebrovascular Disease Prevention Center, 323000 Lishui, Zhejiang, China.
Rev Cardiovasc Med. 2024 May 16;25(5):174. doi: 10.31083/j.rcm2505174. eCollection 2024 May.
Post-stroke cognitive impairment (PSCI) represents a serious post-stroke complication with poor cognitive consequences. A vascular consequence after a stroke is that the occurrence and progression of PSCI may be closely related to blood pressure (BP). Thus, we systematically reviewed and performed a meta-analysis of the literature to examine the correlations between BP and PSCI.
We systematically queried databases, including PubMed, the Cochrane Library, Embase, and Scopus, and conducted meta-analyses on studies reporting odds ratios (ORs) related to the association between BP and PSCI. Two authors autonomously assessed all titles, abstracts, and full texts and extracted data following the Meta-Analysis of Observational Studies in Epidemiology guidelines. The quality of the studies was evaluated using the modified Newcastle-Ottawa scale.
Meta-analyses incorporated 12 articles comprising a cumulative participant cohort of 21,732 individuals. The quality assessment indicated good in five studies, fair in one study, and poor in six. Through meta-analyses, we found that hypertension, systolic or diastolic BP (SBP or DBP) was significantly associated with PSCI (OR 1.53, 95% confidence interval (CI), 1.18-1.99; = 0.001, = 66%; OR 1.13, 95% CI, 1.05-1.23; = 0.002, = 52%; OR 1.38, 95% CI, 1.11-1.72; = 0.004, = 90%, respectively). In the subgroup analysis, SBP 120 mmHg, 120-139 mmHg, 140-159 mmHg, 160-179 mmHg, and DBP 100 mmHg highly predicted the occurrence of PSCI (OR 1.15, = 0.0003; OR 1.26, = 0.010; OR 1.15, = 0.05; OR 1.02, = 0.009; OR 1.96, 0.00001, respectively). However, the predictive effect of BP for PSCI declines when SBP 180 mmHg and DBP 99 mmHg ( 0.05). Statistical heterogeneity was moderate to high, and publication bias was detected in SBP for PSCI.
Considering the multifactorial etiology of PSCI, it is difficult to conclude that BP is an independent risk factor for PSCI. Given the restricted inclusion of studies, caution is advised when interpreting the findings from this meta-analysis. Subsequent investigations with substantial sample sizes are essential to exploring BP as a prospective target for addressing PSCI.
CRD42023437783 from PROSPERO.
卒中后认知障碍（PSCI）是一种严重的卒中后并发症，会导致不良认知后果。卒中后的一个血管性后果是，PSCI的发生和进展可能与血压（BP）密切相关。因此，我们系统回顾并进行了文献荟萃分析，以研究BP与PSCI之间的相关性。
我们系统检索了包括PubMed、Cochrane图书馆、Embase和Scopus在内的数据库，并对报告BP与PSCI关联的比值比（OR）的研究进行了荟萃分析。两名作者按照《流行病学观察性研究荟萃分析指南》自主评估了所有标题、摘要和全文，并提取数据。使用改良的纽卡斯尔-渥太华量表评估研究质量。
荟萃分析纳入了12篇文章，累计参与者队列达21732人。质量评估显示，5项研究质量良好，1项研究质量中等，6项研究质量较差。通过荟萃分析，我们发现高血压、收缩压或舒张压（SBP或DBP）与PSCI显著相关（OR分别为1.53，95%置信区间（CI）为1.18 - 1.99；P = 0.001，I² = 66%；OR为1.13，95%CI为1.05 - 1.23；P = 0.002，I² = 52%；OR为1.38，95%CI为1.11 - 1.72；P = 0.004，I² = 90%）。在亚组分析中，SBP≥120 mmHg、120 - 139 mmHg、140 - 159 mmHg、160 - 179 mmHg以及DBP≥100 mmHg高度预测PSCI的发生（OR分别为1.15，P = 0.0003；OR为1.26，P = 0.010；OR为1.15，P = 0.05；OR为1.02，P = 0.009；OR为1.96，P < 0.00001）。然而，当SBP≥180 mmHg和DBP≥99 mmHg时，BP对PSCI的预测作用下降（P < 0.05）。统计异质性为中度到高度，并且在PSCI的SBP分析中检测到发表偏倚。
考虑到PSCI的多因素病因，难以得出BP是PSCI的独立危险因素的结论。鉴于纳入研究有限，在解释本荟萃分析的结果时建议谨慎。后续进行大样本量的研究对于探索将BP作为解决PSCI的前瞻性靶点至关重要。
来自PROSPERO的CRD42023437783
