The Robert Larner, M.D. College of Medicine at the University of Vermont Burlington VT USA.
Department of Biostatistics School of Public Health University of Alabama at Birmingham Birmingham AL USA.
J Am Heart Assoc. 2024 Sep 3;13(17):e033401. doi: 10.1161/JAHA.123.033401. Epub 2024 Aug 19.
It is unknown how blood pressure (BP) relates to stroke risk across levels of hypertension daily dose (HDD)-quantified antihypertensive medication intensity.
The REGARDS (Reasons for Geographic and Racial Differences in Stroke) study enrolled 30 239 participants from the 48 contiguous US states in 2003 to 2007 with in-person follow-up in 2013 to 2016 (Visit 2). We included those without prior stroke at Visit 2, treating this visit as T. Biannual phone calls and medical record review ascertained incident stroke events. Cox proportional hazard models estimated the hazard ratio (HR) of incident stroke by treatment intensity defined by systolic BP stages and HDD groupings. There were 344 stroke events over a median 5.5 years. Relative to systolic BP <120 mm Hg and no antihypertensive medications, the stroke HR was 2.86 (95% CI, 1.68-4.85) for systolic BP 140 to 159 mm Hg and HDD tertile 2, 2.33 (1.37-3.97) for systolic BP 140 to 159 mm Hg and HDD tertile 3, 3.08 (1.20-7.88) for systolic BP ≥160 mm Hg and HDD tertile 2, and 3.66 (1.61-8.30) for systolic BP ≥160 mm Hg and HDD tertile 3. Stroke risk was similar across HDD levels for people with systolic BP <140 mm Hg.
Among adults without prior stroke, systolic BP ≥140 mm Hg and HDD tertile ≥2 was associated with greater stroke risk. For adults with BP <140 mm Hg, stroke risk was similar despite cumulative dose of antihypertensive medications used. These findings support the practice of BP-lowering medications to mitigate stroke risk.
目前尚不清楚血压（BP）与高血压日剂量（HDD）量化降压药物强度水平相关的卒中风险之间的关系。
REGARDS（地理和种族差异导致卒中的原因）研究于 2003 年至 2007 年从美国 48 个州招募了 30239 名参与者，2013 年至 2016 年进行了随访（访视 2）。我们纳入了访视 2 时无既往卒中的患者，将该访视作为 T 期。每半年进行一次电话随访和病历审查以确定卒中事件的发生。使用 Cox 比例风险模型根据收缩压阶段和 HDD 分组定义治疗强度，估计卒中发生率的风险比（HR）。中位随访时间为 5.5 年，共发生 344 例卒中事件。与收缩压<120mmHg 且未服用降压药物相比，收缩压 140 至 159mmHg 且 HDD 三分位 2 组的卒中 HR 为 2.86（95%CI，1.68-4.85），收缩压 140 至 159mmHg 且 HDD 三分位 3 组的卒中 HR 为 2.33（1.37-3.97），收缩压≥160mmHg 且 HDD 三分位 2 组的卒中 HR 为 3.08（1.20-7.88），收缩压≥160mmHg 且 HDD 三分位 3 组的卒中 HR 为 3.66（1.61-8.30）。对于收缩压<140mmHg 的患者，不同 HDD 水平之间的卒中风险相似。
在无既往卒中的成年人中，收缩压≥140mmHg 和 HDD 三分位≥2 与更高的卒中风险相关。对于收缩压<140mmHg 的成年人，尽管使用的降压药物累积剂量不同，但卒中风险相似。这些发现支持使用降压药物降低卒中风险的做法。
