Blood Pressure Trajectories and the Risk of Intracerebral Hemorrhage and Cerebral Infarction: A Prospective Study.
Blood Pressure Trajectories and the Risk of Intracerebral Hemorrhage and Cerebral Infarction: A Prospective Study.
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DOI：
10.1161/hypertensionaha.117.09479
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发表时间：
2017-09
期刊：
影响因子：
--
通讯作者：
Gao X
中科院分区：
文献类型：
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作者：
Li W;Jin C;Vaidya A;Wu Y;Rexrode K;Zheng X;Gurol ME;Ma C;Wu S;Gao X
社区居住成年人长期血压模式与脑出血和脑梗死风险之间的关系尚不明确。这项前瞻性研究包括79，385名参与者，在2010年或之前（基线）没有中风，心肌梗死和癌症。使用2006年、2008年和2010年的数据，使用潜在混合模型确定了收缩压轨迹。2010年至2014年期间发生脑出血和脑梗死事件，由3名医生通过审查病历证实。我们在2006年至2010年期间确定了5种不同的收缩压轨迹。每个轨迹都根据其血压范围和随时间变化的模式进行标记：正常血压稳定（n= 26，740）、高血压前期稳定（n= 35，674）、1期高血压升高（n= 8，215）、1期高血压降低（n= 6，422）和2期高血压稳定（n= 2，334）。我们记录了1,034例脑梗死和187例脑出血事件。虽然高血压前期稳定的轨迹显示收缩压范围在“正常”范围内，（120-140 mmHg），相对于血压正常-稳定组，（<120 mmHg）（脑出血和脑梗死的校正风险比分别为3.11和1.99; P<0.001）。与血压正常稳定组相比，处于2级高血压稳定收缩压轨迹（175-179 mmHg）的个体发生脑出血（校正风险比为12.4）和脑梗死（校正风险比为5.07）的风险最高（两者均P<0.001）。血压轨迹与中风风险相关，在目前指定的“正常”范围内增加血压轨迹仍可能增加中风风险。
The association between long-term blood pressure patterns in community-dwelling adults and risk of intracerebral hemorrhage and cerebral infarction is not well-characterized. This prospective study included 79,385 participants, free of stroke, myocardial infarction and cancer in or prior to 2010(baseline). Systolic blood pressure trajectories were identified using latent mixture modeling with data from 2006, 2008 and 2010. Incident cases of intracerebral hemorrhage and cerebral infarction occurred during 2010 to 2014, confirmed by review of medical records, by three physicians. We identified 5 distinct systolic blood pressure trajectories during 2006 to 2010. Each of the trajectories was labelled according to their blood pressure range and pattern over time: normotensive-stable(n=26,740), prehypertension-stable(n=35,674), stage 1 hypertension-increasing(n=8,215), stage 1 hypertension-decreasing(n=6,422), and stage 2 hypertension-stable(n=2,334). We documented 1,034 incident cases of cerebral infarction and 187 cases of intracerebral hemorrhage. Although the prehypertension-stable trajectory exhibited systolic blood pressure range within the “normal” range(120–140 mmHg) during 2006 to 2010, this group had higher stroke risk relative to the normotensive-stable group(<120 mmHg) (adjusted hazard ratio was 3.11 for intracerebral hemorrhage and 1.99 for cerebral infarction; P<0.001 for both), after adjusting for possible confounders. Individuals in the stage 2 hypertension-stable systolic blood pressure trajectory (175–179 mmHg) had the highest risk of intracerebral hemorrhage(adjusted hazard ratio was 12.4) and cerebral infarction (adjusted hazard ratio was 5.07), relative to the normotensive-stable group(P<0.001 for both). Blood pressure trajectories were associated with the risk of stroke and increasing blood pressure trajectories within the currently designated “normal” range may still increase the risk for stroke.