Intensive or standard blood pressure control in patients with a history of ischemic stroke: RESPECT post hoc analysis
Intensive or standard blood pressure control in patients with a history of ischemic stroke: RESPECT post hoc analysis
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DOI：
10.1038/s41440-022-00862-y
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发表时间：
2022-03-04
影响因子：
5.4
通讯作者：
Shimada, Kazuyuki
中科院分区：
文献类型：
--
作者：
Kitagawa, Kazuo;Arima, Hisatomi;Shimada, Kazuyuki
复发性中风预防临床结果 (RESPECT) 研究及其汇总分析表明，强化降血压 (BP) 可将有中风病史的患者复发性中风风险降低 22%。在这里，我们报告了强化血压降低对有缺血性中风病史的患者复发中风亚型风险的影响。 RESPECT 是一项在 1280 名有脑梗塞或脑出血病史的人中进行的随机临床试验。参与者被分配到强化血压对照组（血压<120/80 mmHg）或标准血压对照组（血压<140/90 mmHg）。在这项事后分析中，我们分析了 1074 名有脑梗塞病史的患者。基线平均血压为 140.7/81.4 mmHg。在整个随访期间，标准组的平均血压为 133.4/77.5 (95% CI, 132.7-134.1/76.9-78.2) mmHg，强化组的平均血压为 126.7/74.1 (95% CI, 126.0-127.4/73.5-74.8) mmHg。在平均 3.9 年的随访期间，发生了 78 例首次复发性中风。强化治疗往往会降低总体年度卒中复发率（强化治疗为 1.74%，标准为 2.17%；对数秩检验 P = 0.351），并且不会改变缺血性卒中风险（1.74% vs. 1.75%，P = 0.999），但显着降低出血性卒中风险（0.00% vs. 0.39%，P = 0.005）。观察到强化血压控制对有缺血性中风病史的患者发生出血性中风风险的有益效果。这项研究的结果表明，强化血压控制对于有缺血性中风病史且出血性中风高风险的患者是有益的。
The Recurrent Stroke Prevention Clinical Outcome (RESPECT) Study and its pooled analysis showed that intensive blood pressure (BP) lowering reduced recurrent stroke risk by 22% in patients with a history of stroke. Here, we report the effect of intensive BP lowering on the risk of recurrent stroke subtypes in patients with a history of ischemic stroke. RESPECT was a randomized clinical trial among 1280 people with a history of cerebral infarction or intracerebral hemorrhage. Participants were assigned to the intensive blood pressure control group (blood pressure < 120/80 mmHg) or standard blood pressure control group (blood pressure < 140/90 mmHg). In this post hoc analysis, we analyzed 1074 patients with a history of cerebral infarction. The mean BP at baseline was 140.7/81.4 mmHg. Throughout the follow-up period, the mean BP was 133.4/77.5 (95% CI, 132.7-134.1/76.9-78.2) mmHg in the standard group and 126.7/74.1 (95% CI, 126.0-127.4/73.5-74.8) mmHg in the intensive group. During a mean follow-up of 3.9 years, 78 first recurrent strokes occurred. Intensive treatment tended to reduce overall annual stroke recurrence (1.74% in intensive vs. 2.17% in standard; P = 0.351 by log-rank test) and did not change the risk of ischemic stroke (1.74% vs. 1.75%, P = 0.999) but markedly reduced the risk of hemorrhagic stroke (0.00% vs. 0.39%, P = 0.005). Beneficial effects of intensive BP control were observed for the risk of hemorrhagic stroke in patients with a history of ischemic stroke. The findings of this study indicate the benefit of intensive BP control for patients with a history of ischemic stroke at high risk of hemorrhagic stroke.