Patterns of blood pressure response during intensive BP lowering and clinical events: results from the secondary prevention of small subcortical strokes trial.
Patterns of blood pressure response during intensive BP lowering and clinical events: results from the secondary prevention of small subcortical strokes trial.
复制标题
强化降压和临床事件期间的血压反应模式：小型皮质下中风二级预防试验的结果。
DOI：
10.1080/08037051.2017.1382310
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发表时间：
2018
期刊：
影响因子：
1.8
通讯作者：
Peralta,CarmenA
中科院分区：
文献类型：
--
作者：
Ku,Elaine;Scherzer,Rebecca;Odden,MichelleC;Shlipak,Michael;White,CaroleL;Field,ThaliaS;Benavente,Oscar;Pergola,PabloE;Peralta,CarmenA
目的：我们应用聚类分析来识别在强化降压过程中收缩压（SBP）、舒张压（DBP）和脉压（PP）的伴随反应的离散模式;并评估它们的临床相关性以及与死亡率、主要血管事件（MVEs）和卒中风险的关联。材料和方法：我们使用了一种无监督的聚类程序来识别1，331名参与小型皮质下卒中二级预防试验的受试者，他们之前被随机分配至较低的BP目标结果：分组程序将参与者分为三组，在较低SBP目标臂中，具有以下特征的人：1）基线SBP轻度升高和访视间BP变异性最小（轻度降低者）; 2）基线SBP中度升高和访视间BP中度变异性（中度降低者）;和3）基线SBP非常升高，强化治疗期间访视间BP变异性非常大（大幅降低者）。在较低SBP目标组中，中度降低者的死亡（校正HR 1.6 [95% CI 1.0-2.7]）、MVE（校正HR 2.1 [95% CI 1.4-3.2]）和卒中（校正HR 2.6[95% CI 1.7-4.1]）风险高于轻度降低者。大型减速器的死亡风险最高（校正HR 2.3 [95% CI 1.2-4.4]），但MVE风险（HR = 1.7 [95%CI 0.9-3.1]）和卒中（HR = 1.6 [95%CI：0.8-3.5]）与轻度减速器相比无统计学显著差异。在既往腔隙性卒中患者中，基线BP水平和强化降压背景下的BP变异性可以识别不良结局风险较高的离散人群。
Purpose:We applied cluster analysis to identify discrete patterns of concomitant responses of systolic (SBP), diastolic (DBP) and pulse pressure (PP) during intensive BP lowering; and to evaluate their clinical relevance and association with risk of mortality, major vascular events (MVEs), and stroke.Material and methods:We used an unsupervised cluster procedure to identify distinct patterns of BP change during the first 9 months of anti-hypertensive therapy intensification among 1,331 participants in the Secondary Prevention of Small Subcortical Strokes Trial who were previously randomized to lower BP target (SBP < 130 mm Hg) after lacunar stroke.Results:The cluster procedure partitioned participants into three groups in the lower SBP target arm, persons with: 1) mildly elevated baseline SBP and minimal visit-to-visit BP variability (mild reducers); 2) moderately elevated baseline SBP and moderate visit-to-visit BP variability (moderate reducers); and 3) very elevated baseline SBP with very large visit-to-visit BP variability during intensification (large reducers). In the lower SBP target group, moderate reducers had a higher risk of death (adjusted HR 1.6 [95% CI 1.0–2.7]), MVE (adjusted HR 2.1 [95% CI 1.4–3.2]), and stroke (adjusted HR 2.6[95% CI 1.7–4.1]) compared to mild reducers. Large reducers had the highest risk of death (adjusted HR 2.3 [95% CI 1.2–4.4]), but risk of MVE (HR = 1.7 [95%CI 0.9–3.1]) and stroke (HR = 1.6 [95%CI: 0.8–3.5]) were not statistically significantly different compared to mild reducers.Conclusions:Among persons with prior lacunar stroke, baseline BP levels, and BP variability in the setting of intensive BP lowering can identify discrete groups of persons at higher risk of adverse outcomes.