Effect of Intensive Blood Pressure Control on Incident Stroke Risk in Patients With Mild Cognitive Impairment.
Effect of Intensive Blood Pressure Control on Incident Stroke Risk in Patients With Mild Cognitive Impairment.
复制标题
强化血压控制对轻度认知障碍患者卒中风险的影响
DOI：
10.1161/strokeaha.122.038818
复制
发表时间：
2022-07
期刊：
影响因子：
8.3
通讯作者：
Sheth, Kevin N.
中科院分区：
文献类型：
--
作者：
de Havenon, Adam;Sharma, Richa;Falcone, Guido J.;Prabhakaran, Shyam;Sheth, Kevin N.
轻度认知障碍的患者发生中风的风险可能更高，但强化血压(BP)控制对这种风险的影响尚未被探索。我们对Sprint试验进行了事后分析，纳入了基线蒙特利尔认知评估(MoCA)评分为19-25且无中风病史的患者。主要结果是在随访期间发生卒中(缺血性和出血性)。我们通过SPRINT随机化ARM(密集与标准BP对照)报告了我们的主要结果的未调整累积风险，并将Cox模型与主要结果进行了匹配，并在随机分组时根据患者的年龄、种族/民族、性别、基线血压、心房颤动、糖尿病和吸烟进行了调整。我们纳入了5091名患者(平均年龄68.2岁，其中44%为女性，56.7%为非西班牙裔白人，50.2%为强化血压控制组)，其中95/5091(1.9%)患者在平均3.8±0.9年的随访期内发生了中风。随机接受标准血压控制的患者发生中风的风险为57/2536(2.3%)，接受强化血压控制的患者发生中风的风险为38/2555(1.5%)(p=0.045)。在调整的COX模型中，强化血压控制的卒中事件风险比为0.65(95%可信区间为0.43-0.98，p=0.040)。尽管Sprint试验没有显示出所有受试者在强化血压控制下中风的减少，但那些在基线时MoCA评分与轻度认知损害一致的人，强化血压控制与较低的中风风险之间存在关联。未来对中风一级预防的试验可能受益于使用基线血管生物标记物的丰富，这些标记物具有较高的风险，如轻度认知障碍。
Patients with mild cognitive impairment may be at higher risk of incident stroke, but the effect of intensive blood pressure (BP) control on that risk has not been explored. We performed a post-hoc analysis of the SPRINT trial and included patients with a baseline Montreal Cognitive Assessment (MoCA) score of 19-25 and without a prior history of stroke. The primary outcome was incident stroke (ischemic and hemorrhagic) during follow-up. We report the unadjusted cumulative risk our primary outcome by SPRINT randomization arm (intensive vs. standard BP control) and also fit Cox models to the primary outcome and adjusted for patient age at randomization, race/ethnicity, sex, baseline blood pressure, atrial fibrillation, diabetes, and smoking. We included 5091 patients (mean age 68.2, 44% female, 56.7% non-Hispanic white, and 50.2% randomized to intensive BP control), of which 95/5091 (1.9%) had an incident stroke during a mean of 3.8±0.9 years of follow-up. The risk of incident stroke in patients randomized to standard BP control was 57/2536 (2.3%) and to intensive BP control was 38/2555 (1.5%) (p=0.045). In the adjusted Cox model, the hazard ratio for incident stroke events with intensive BP control was 0.65 (95% CI 0.43-0.98, p=0.040). Although the SPRINT trial failed to show a reduction in stroke with intensive BP control for all subjects, those with a MoCA score consistent with mild cognitive impairment at baseline had an association between intensive BP control and lower risk of incident stroke. Future trials of primary prevention of stroke may benefit from enrichment using baseline vascular biomarkers of elevated risk, such as mild cognitive impairment.