Long-Term Blood Pressure Variability and Major Adverse Cardiovascular and Cerebrovascular Events After Intracerebral Hemorrhage.
Long-Term Blood Pressure Variability and Major Adverse Cardiovascular and Cerebrovascular Events After Intracerebral Hemorrhage.
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长期血压变异性以及脑出血后主要不良心血管和脑血管事件。
DOI：
10.1161/jaha.121.024158
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发表时间：
2022-03-15
影响因子：
5.4
通讯作者：
Biffi, Alessandro
中科院分区：
文献类型：
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作者：
Castello, Juan Pablo;Teo, Kay-Cheong;Abramson, Jessica R.;Keins, Sophia;Takahashi, Courtney E.;Leung, Ian Y. H.;Leung, William C. Y.;Wang, Yujie;Kourkoulis, Christina;Myserlis, Evangelos Pavlos;Warren, Andrew D.;Henry, Jonathan;Chan, Koon-Ho;Cheung, Raymond T. F.;Ho, Shu-Leong;Gurol, M. Edip;Viswanathan, Anand;Greenberg, Steven M.;Anderson, Christopher D.;Lau, Kui-Kai;Rosand, Jonathan;Biffi, Alessandro
颅内出血 (ICH) 的幸存者发生主要不良心血管和脑血管事件 (MACCE) 的风险增加，表现为复发性中风和心肌梗死。我们研究了长期血压 (BP) 变异是否代表 ICH 后发生 MACCE 的危险因素，与平均血压无关。我们分析了麻省总医院和香港大学的前瞻性 ICH 队列研究的数据。我们捕获了长期（即访问间）血压变异性，量化为个体参与者的变异系数。我们探索了收缩压和舒张压变异性的决定因素，并生成了生存分析模型来探讨它们与 MACCE 的关联。在 1828 名脑出血幸存者中，我们对 166 名脑出血幸存者进行了平均 46.2 个月的随访，其中 166 名患者患有复发性脑出血，68 名患者患有缺血性中风，69 名患者患有心肌梗死。黑人（系数+3.8，SE 1.3）和亚洲人（系数+2.2，SE 0.4）参与者表现出较高的血压变异性。长期收缩压变异性与复发性ICH（亚危险比[SHR]，1.82；95% CI，1.19-2.79）、缺血性卒中（SHR，1.62；95% CI，1.06-2.47）和心肌梗死（SHR，1.54；95% CI，1.05-2.24）独立相关。随访期间的平均血压并未改变长期收缩压变异性与 MACCE 之间的关联。长期血压变异是脑出血后复发性出血、缺血性中风和心肌梗死的一个潜在危险因素，即使对于高血压控制良好的幸存者也是如此。我们的研究结果支持以下假设：需要结合控制 ICH 后的平均血压及其变异性，以尽量减少 MACCE 的发生率。
Survivors of intracranial hemorrhage (ICH) are at increased risk for major adverse cardiovascular and cerebrovascular events (MACCE), in the form of recurrent stroke and myocardial Infarction. We investigated whether long‐term blood pressure (BP) variability represents a risk factor for MACCE after ICH, independent of average BP. We analyzed data from prospective ICH cohort studies at Massachusetts General Hospital and the University of Hong Kong. We captured long‐term (ie, visit‐to‐visit) BP variability, quantified as individual participants’ variation coefficient. We explored determinants of systolic and diastolic BP variability and generated survival analyses models to explore their association with MACCE. Among 1828 survivors of ICH followed for a median of 46.2 months we identified 166 with recurrent ICH, 68 with ischemic strokes, and 69 with myocardial infarction. Black (coefficient +3.8, SE 1.3) and Asian (coefficient +2.2, SE 0.4) participants displayed higher BP variability. Long‐term systolic BP variability was independently associated with recurrent ICH (subhazard ratio [SHR], 1.82; 95% CI, 1.19–2.79), ischemic stroke (SHR, 1.62; 95% CI, 1.06–2.47), and myocardial infarction (SHR, 1.54; 95% CI, 1.05–2.24). Average BP during follow‐up did not modify the association between long‐term systolic BP variability and MACCE. Long‐term BP variability is a potent risk factor for recurrent hemorrhage, ischemic stroke, and myocardial infarction after ICH, even among survivors with well‐controlled hypertension. Our findings support the hypothesis that combined control of average BP and its variability after ICH is required to minimize incidence of MACCE.