Maeda Toshiki, Ohya Yuichiro, Ishida Shintaro, Inoue Yori, Fujii Takako, Sakamoto Yuki, Okina Norihito, Niijima Tetsutaro, Arima Hisatomi, Toyoda Kazunori, Kai Hisashi, Koga Masatoshi
Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Division of Neurology, NHO Okinawa Hospital, Okinawa, Japan.
Hypertens Res. 2025 Mar 17. doi: 10.1038/s41440-025-02183-2.
In this systematic review of randomized controlled trials, we examined the optimal blood pressure (BP) target for patients with prior stroke, comparing intensive BP control (systolic BP [SBP] <130 mmHg) with standard BP control (SBP < 140 mmHg). Literature searches of PubMed/MEDLINE, the Cochrane Database, and Ichu-shi identified seven randomized controlled trials for quantitative analysis. Meta-analyses were performed using random-effects models, with most included trials assessed as having low risks of bias. The meta-analysis showed significant reductions in recurrent stroke (risk ratio [RR], 0.79; 95% confidence interval [CI], 0.65-0.96) and major cardiovascular events (RR, 0.86; 95% CI, 0.76-0.97) in the intensive BP control arm. Intensive BP control was more effective in reducing recurrent hemorrhagic stroke (RR, 0.33; 95% CI, 0.15-0.74) than ischemic stroke (RR, 0.87; 95% CI, 0.71-1.08). However, adverse events such as syncope or dizziness were significantly more frequent in the intensive BP control arm (RR, 1.30; 95% CI, 1.00-1.68). Absolute risk reductions (per 1,000 persons) for recurrent stroke (-14; 95% CI, -24 to -4) and major cardiovascular events (-17; 95% CI, -28 to -6) outweighed the absolute increase in syncope or dizziness (4; 95% CI, 0-9). We recommend a lower SBP target of <130 mmHg, with careful monitoring for hypotension-related symptoms, to prevent recurrent stroke and major cardiovascular events in patients with prior stroke.
在这项对随机对照试验的系统评价中，我们研究了既往有卒中病史患者的最佳血压（BP）目标，比较了强化血压控制（收缩压[ SBP]<130 mmHg）与标准血压控制（SBP<140 mmHg）。通过对PubMed/MEDLINE、Cochrane数据库和Ichu-shi进行文献检索，确定了7项随机对照试验进行定量分析。使用随机效应模型进行荟萃分析，大多数纳入试验的偏倚风险较低。荟萃分析显示，强化血压控制组的复发性卒中（风险比[RR]，0.79；95%置信区间[CI]，0.65 - 0.96）和主要心血管事件（RR，0.86；95% CI，0.76 - 0.97）显著减少。强化血压控制在减少复发性出血性卒中（RR，0.33；95% CI，0.15 - 0.74）方面比缺血性卒中（RR，0.87；95% CI，0.71 - 1.08）更有效。然而，强化血压控制组中晕厥或头晕等不良事件明显更频繁（RR，1.30；95% CI，1.00 - 1.68）。复发性卒中（-14；95% CI，-24至-4）和主要心血管事件（-17；95% CI，-28至-6）每1000人的绝对风险降低超过晕厥或头晕的绝对增加量（4；95% CI，0 - 9）。我们建议将SBP目标降至<130 mmHg，并仔细监测低血压相关症状，以预防既往有卒中病史患者的复发性卒中和主要心血管事件。
