Cao Tianyu, Cheng Zaihua, Wei Yaping, Ding Congcong, Lu WenYang, Gao Lan, Liu Lishun, Zhang Yan, Li Jianping, Huo Yong, Spence J David, Wang Xiaobin, Cheng Xiaoshu, Wang Hong, Huang Xiao
Department of Cardiology, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
Biological Anthropology, University of California Santa Barbara, Santa Barbara, California, USA.
Eur J Neurol. 2025 May;32(5):e70178. doi: 10.1111/ene.70178.
Whether hypertensive patients with elevated arterial stiffness and central systolic blood pressure (cSBP) are exposed to higher stroke risk is unclear.
A total of 6663 participants without a history of cardiovascular disease were enrolled in this study. cSBP was measured noninvasively using the A-Pulse CASPro device; carotid-femoral pulse wave velocity (cfPWV) was collected using a Pulse Pen device. The primary outcome was incident stroke.
Over 4.4 years (median), 454 incident strokes occurred (15.92 per 1000 person-years). Compared to the reference group (cSBP < 137 mmHg and cfPWV < 10 m/s), patients with elevated cSBP and cfPWV had a significantly increased risk of incident stroke (HR 1.78 [95% CI 1.39, 2.27]), and were the only group showing statistical significance versus those with solely increased cSBP (HR 1.13 [95% CI 0.87, 1.48]) or cfPWV (HR 1.15 [95% CI 0.87, 1.52]) after adjusting for covariates; p for trend < 0.001. Consistent findings were identified in multiple sensitivity and exploratory analyses. The additive interaction between elevated cSBP and cfPWV was significant, with a relative excess risk due to interaction of 0.55 [95% CI 0.05-1.03]. The association between elevated cSBP and cfPWV with incident stroke risk was more robust among patients who were taking non-guideline recommended antihypertensive medication at baseline (HR 3.03) than among those who took recommended regimens (HR 1.58).
Hypertensive patients with elevated cSBP and cfPWV have a significantly higher risk of incident stroke than those with lower or solely increased cSBP and cfPWV. Greater clinical attention and tailored treatment strategies are needed.
尚不清楚动脉僵硬度升高且中心收缩压（cSBP）升高的高血压患者是否面临更高的中风风险。
本研究共纳入6663名无心血管疾病病史的参与者。使用A-Pulse CASPro设备无创测量cSBP；使用脉搏笔设备收集颈股脉搏波速度（cfPWV）。主要结局为新发中风。
在4.4年（中位数）的时间里，发生了454例新发中风（每1000人年15.92例）。与参照组（cSBP<137mmHg且cfPWV<10m/s）相比，cSBP和cfPWV升高的患者发生新发中风的风险显著增加（HR 1.78[95%CI 1.39,2.27]），并且是在调整协变量后与单纯cSBP升高（HR 1.13[95%CI 0.87,1.48]）或cfPWV升高（HR 1.15[95%CI 0.87,1.52]）的患者相比显示出统计学显著性的唯一组；趋势p<0.001。在多项敏感性和探索性分析中发现了一致的结果。cSBP升高与cfPWV之间的相加交互作用显著，交互作用导致的相对超额风险为0.55[95%CI 0.05-1.03]。在基线时服用非指南推荐降压药物的患者中，cSBP和cfPWV升高与新发中风风险之间的关联（HR 3.03）比服用推荐方案的患者（HR 1.58）更强。
cSBP和cfPWV升高的高血压患者发生新发中风的风险显著高于cSBP和cfPWV较低或仅其中一项升高的患者。需要更多的临床关注和针对性的治疗策略。
