Ding Congcong, Cao Tianyu, Cheng Zaihua, Liu Lishun, Chen Zihan, Lu Wenyang, Yu Yaren, Gao Lan, Jiang Chongfei, Song Yun, Li Junpei, Fan Fangfang, Zhang Yan, Li Jianping, Huo Yong, Wang Hong, Wang Xiaobin, Parati Gianfranco, Huang Xiao, Cheng Xiaoshu
Department of Cardiovascular Medicine, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang of Jiangxi, China.
Biological Anthropology, University of California Santa Barbara, Santa Barbara, California, USA.
J Hypertens. 2025 Mar 1;43(3):428-435. doi: 10.1097/HJH.0000000000003921. Epub 2024 Nov 25.
It is unclear whether central SBP (cSBP) is an independent predictor of stroke above and beyond brachial SBP (bSBP). This study aimed to investigate the difference between cSBP and bSBP in predicting first stroke and the joint effect of cSBP and bSBP on the risk of first stroke in hypertensive adults.
A total of 8122 hypertensive adults without stroke history were included in this study. cSBP was measured noninvasively using A-Pulse CASPro device. The outcome was first stroke. During a median follow-up of 4.4 years, 579 first strokes were identified.
A total of 8122 hypertensive adults without stroke history were included in this study. cSBP was measured noninvasively using A-Pulse CASPro device. The outcome was first stroke. During a median follow-up of 4.4 years, 579 first strokes were identified. The risk of first stroke increased by the same 16% [hazard ratio: 1.16, 95% confidence interval (95% CI): 1.07-1.26] for per SD increment in both cSBP and bSBP. The differences in areas under the curves, continuous net reclassification indices, and integrated discrimination indices of bSBP and cSBP models for predicting first stroke were 0.003 (95% CI: -0.003, 0.008), 0.007 (95% CI: -0.058, 0.071), and -0.0002 (95% CI: -0.0028, 0.0013), respectively. When cSBP and bSBP were evaluated jointly, participants in the highest tertiles of both cSBP and bSBP had the highest risk of first stroke compared with their counterparts (hazard ratio: 1.59, 95% CI: 1.29-1.96; P -interaction = 0.034). Similar results were found for ischemic stroke and hemorrhagic stroke.
Although cSBP was not found to be superior to bSBP in predicting first stroke, cSBP and bSBP were jointly associated with the risk of first stroke among hypertensive adults.
尚不清楚中心收缩压（cSBP）是否是肱动脉收缩压（bSBP）之外的独立卒中预测指标。本研究旨在探讨cSBP与bSBP在预测首次卒中方面的差异，以及cSBP和bSBP对高血压成年人首次卒中风险的联合影响。
本研究共纳入8122例无卒中病史的高血压成年人。使用A-Pulse CASPro设备无创测量cSBP。观察结局为首次卒中。在中位随访4.4年期间，共识别出579例首次卒中。
本研究共纳入8122例无卒中病史的高血压成年人。使用A-Pulse CASPro设备无创测量cSBP。观察结局为首次卒中。在中位随访4.4年期间，共识别出579例首次卒中。cSBP和bSBP每增加1个标准差，首次卒中风险均增加相同的16%[风险比：1.16，95%置信区间（95%CI）：1.07-1.26]。bSBP和cSBP预测首次卒中模型的曲线下面积、连续净重新分类指数和综合判别指数的差异分别为0.003（95%CI：-0.003，0.008）、0.007（95%CI：-0.058，0.071）和-0.0002（95%CI：-0.0028，0.0013）。当联合评估cSBP和bSBP时，cSBP和bSBP均处于最高三分位数的参与者与其他参与者相比，首次卒中风险最高（风险比：1.59，95%CI：1.29-1.96；P交互作用=0.034）。缺血性卒中和出血性卒中也发现了类似结果。
虽然在预测首次卒中方面未发现cSBP优于bSBP，但cSBP和bSBP与高血压成年人首次卒中风险联合相关。
