Blood Pressure Control Targets and Risk of Cardiovascular and Cerebrovascular Events After Intracerebral Hemorrhage.
Blood Pressure Control Targets and Risk of Cardiovascular and Cerebrovascular Events After Intracerebral Hemorrhage.
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脑出血后血压控制目标和心脑血管事件的风险。
DOI：
10.1161/strokeaha.122.039709
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发表时间：
2023
期刊：
影响因子：
8.3
通讯作者：
Green
中科院分区：
文献类型：
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作者：
Teo,Kay-Cheong;Keins,Sophia;Abramson,JessicaR;Leung,WilliamCY;Leung,IanYH;Wong,Yuen-Kwun;Yeung,Charming;Kourkoulis,Christina;Warren,AndrewD;Chan,Koon-Ho;Cheung,RaymondTF;Ho,Shu-Leong;Gurol,MEdip;Viswanathan,Anand;Green
研究背景脑出血（Intracerebral hemorrhage，ICH）幸存者是复发性卒中和心血管事件的高危人群.血压（BP）控制是降低这些风险的最有效干预措施，但该患者人群的最佳治疗目标仍然未知。我们试图确定是否幸存者ICH实现更密集的血压控制比目前的指南建议（收缩压<130毫米汞柱和舒张压<80毫米汞柱）的主要不良心血管和脑血管事件和mortals.MethodsWe分析了2个队列研究的1828自发性ICH幸存者的数据。在ICH后3个月和6个月以及此后每6个月记录一次随访血压测量结果。关注的结局是主要的心血管和脑血管不良事件（复发性ICH、缺血性卒中事件、心肌梗死）、血管死亡率（定义为归因于复发性ICH、缺血性卒中或心肌梗死的死亡率）和全因死亡率。结果在46.2个月的中位随访期间，我们观察到166例复发性ICH，68例缺血性卒中，69例心肌梗死，429人死亡与收缩压120 - 129 mmHg的ICH幸存者相比，收缩压<120 mmHg的受试者显示复发性ICH（校正风险比[AHR]，0.74 [95% CI，0.59-0.94]）和主要不良心血管和脑血管事件（AHR，0.69 [95% CI，0.53-0.92]）的风险降低。全因死亡率（AHR，0.76 [95%CI，0.57-1.03]）和血管死亡率（AHR，0.68 [95%CI，0.45-1.01]）没有显着差异。在年龄>75岁或改良兰金量表评分为4 - 5分的受试者中，收缩压<120 mmHg与全因死亡率增加相关（AHR分别为1.38 [95%CI，1.02-1.85]和1.36 [95%CI，1.03-1.78]），但与血管性死亡率无关。我们发现，ICH的幸存者与舒张压<70与70至79 mmHg之间的结局率没有差异。结论：在选择的ICH幸存者组中，以收缩压<120 mmHg为目标可以降低主要不良心血管和脑血管事件的风险，而不增加死亡率。我们的发现值得在专门的随机对照试验中进行调查。
BackgroundIntracerebral hemorrhage (ICH) survivors are at high risk for recurrent stroke and cardiovascular events. Blood pressure (BP) control represents the most potent intervention to lower these risks, but optimal treatment targets in this patient population remain unknown. We sought to determine whether survivors of ICH achieving more intensive BP control than current guideline recommendations (systolic BP <130 mmHg and diastolic BP <80 mmHg) were at lower risk of major adverse cardiovascular and cerebrovascular events and mortality.MethodsWe analyzed data for 1828 survivors of spontaneous ICH from 2 cohort studies. Follow-up BP measurements were recorded 3 and 6 months after ICH, and every 6 months thereafter. Outcomes of interest were major adverse cardiovascular and cerebrovascular events (recurrent ICH, incident ischemic stroke, myocardial infarction), vascular mortality (defined as mortality attributed to recurrent ICH, ischemic stroke, or myocardial infarction), and all-cause mortality.ResultsDuring a median follow-up of 46.2 months, we observed 166 recurrent ICH, 68 ischemic strokes, 69 myocardial infarction, and 429 deaths. Compared with survivors of ICH with systolic BP 120 to 129 mmHg, participants who achieved systolic BP <120 mmHg displayed reduced risk of recurrent ICH (adjusted hazard ratio [AHR], 0.74 [95% CI, 0.59–0.94]) and major adverse cardiovascular and cerebrovascular events (AHR, 0.69 [95% CI, 0.53–0.92]). All-cause mortality (AHR, 0.76 [95% CI, 0.57–1.03]) and vascular mortality (AHR, 0.68 [95% CI, 0.45–1.01]) did not differ significantly. Among participants aged >75 years or with modified Rankin Scale score 4 to 5, systolic BP <120 mmHg was associated with increased all-cause mortality (AHR, 1.38 [95% CI, 1.02–1.85] and AHR, 1.36 [95% CI, 1.03–1.78], respectively), but not vascular mortality. We found no differences in outcome rates between survivors of ICH with diastolic BP <70 versus 70 to 79 mmHg.ConclusionsTargeting systolic BP <120 mmHg in select groups of survivors of ICH could result in decreased major adverse cardiovascular and cerebrovascular events risk without increasing mortality. Our findings warrant investigation in dedicated randomized controlled trials.