JAHA:CSPPT研究全新分析:血压波动增加中风危险,偶发高血压也不能轻易放过

2017-03-22 卢芳 中国循环杂志

北京大学第一医院学者通过对CSPPT研究2万余高血压患者随访数据分析发现,随诊间收缩压波动是高血压患者首次卒中发生的独立危险因素,尤其对于缺血性脑卒中,而且独立于平均收缩压。研究显示,随诊次数越多,其收缩压波动对之后卒中预测越有价值,不过多于10次,预测价值似乎不太明显;随诊间收缩压波动越大,卒中风险越高。图1  6次随访间收缩压波动情况五分位数相对应的卒中风险值得注意的是,对于血压控制

北京大学第一医院学者通过对CSPPT研究2万余高血压患者随访数据分析发现,随诊间收缩压波动是高血压患者首次卒中发生的独立危险因素,尤其对于缺血性脑卒中,而且独立于平均收缩压。

研究显示,随诊次数越多,其收缩压波动对之后卒中预测越有价值,不过多于10次,预测价值似乎不太明显;随诊间收缩压波动越大,卒中风险越高。


图1  6次随访间收缩压波动情况五分位数相对应的卒中风险

值得注意的是,对于血压控制较差,收缩压≥140 mmHg者,随诊间收缩压波动最具卒中预测价值。这提示,平均收缩压和随诊间收缩压波动在血压管理中是同等重要的。

此外,研究还显示,在女性、老年患者、肥胖人群,也应该注意其随诊间收缩压波动水平。

不过该研究未显示出随诊间收缩压波动与出血性卒中的显着相关性,但研究者认为关注收缩压波动还是有意义的。

在该研究中,有18.8%的卒中患者为出血性脑卒中,占整体受试人群的0.57%。而且,平均收缩压水平显示对出血性脑卒中具有预测价值。

另外,之前来自CSPPT研究的一项随访1.5年的分析结果显示,血压波动可加速脑微出血的进展。

研究者指出,该研究提示,在临床实践中,对于偶发高血压者不应该轻易放过。此外,即使在随访时血压控制在正常范围者,也仍有可能存在高血压。

鉴于此,临床医生应该加强对高血压患者血压波动的认识,而非仅仅一次随诊时表现的正常血压。

此外,在应用降压药物时,要兼顾平均血压的降低和随诊间血压波动的改善,其中钙拮抗剂被证明对于降低随诊间血压波动更为有效,而β受体阻滞剂和血管紧张素受体阻断剂却会增加随诊间血压波动。

该研究回顾性分析了CSPPT研究中32个社区20702例高血压患者随访时收缩压变异相关数据。受试者的血压每隔3个月测量1次。中位随访4.5年期间,有597人发生卒中。

原始出处:

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (4)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=2023331, encodeId=1cb42023331d5, content=<a href='/topic/show?id=55d4889548b' target=_blank style='color:#2F92EE;'>#血压波动#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88954, encryptionId=55d4889548b, topicName=血压波动)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6ab940, createdName=hukaixun, createdTime=Mon Nov 20 10:16:00 CST 2017, time=2017-11-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2077267, encodeId=86b620e7267bc, content=<a href='/topic/show?id=2716535631' target=_blank style='color:#2F92EE;'>#CSP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=133, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5356, encryptionId=2716535631, topicName=CSP)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eq2AGzrugK9ZUjU3eJxzM901ophWib0xJDrSicy49ibWl3zB5pbDto7eoR6tnzwOiaKdbq1a8PcbYFFrw/132, createdBy=6ff22500098, createdName=ms4964546379600229, createdTime=Thu Apr 20 01:16:00 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1947520, encodeId=649f194e520b3, content=<a href='/topic/show?id=360f14591e2' target=_blank style='color:#2F92EE;'>#PPT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14591, encryptionId=360f14591e2, topicName=PPT)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/101296147/78FA0899509C358B01B975E8EAC1F88A/100, createdBy=7d822500145, createdName=ms5353107019656438, createdTime=Mon Feb 05 19:16:00 CST 2018, time=2018-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1267406, encodeId=0cab126e406f1, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Fri Mar 24 03:16:00 CST 2017, time=2017-03-24, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=2023331, encodeId=1cb42023331d5, content=<a href='/topic/show?id=55d4889548b' target=_blank style='color:#2F92EE;'>#血压波动#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88954, encryptionId=55d4889548b, topicName=血压波动)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6ab940, createdName=hukaixun, createdTime=Mon Nov 20 10:16:00 CST 2017, time=2017-11-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2077267, encodeId=86b620e7267bc, content=<a href='/topic/show?id=2716535631' target=_blank style='color:#2F92EE;'>#CSP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=133, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5356, encryptionId=2716535631, topicName=CSP)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eq2AGzrugK9ZUjU3eJxzM901ophWib0xJDrSicy49ibWl3zB5pbDto7eoR6tnzwOiaKdbq1a8PcbYFFrw/132, createdBy=6ff22500098, createdName=ms4964546379600229, createdTime=Thu Apr 20 01:16:00 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1947520, encodeId=649f194e520b3, content=<a href='/topic/show?id=360f14591e2' target=_blank style='color:#2F92EE;'>#PPT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14591, encryptionId=360f14591e2, topicName=PPT)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/101296147/78FA0899509C358B01B975E8EAC1F88A/100, createdBy=7d822500145, createdName=ms5353107019656438, createdTime=Mon Feb 05 19:16:00 CST 2018, time=2018-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1267406, encodeId=0cab126e406f1, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Fri Mar 24 03:16:00 CST 2017, time=2017-03-24, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=2023331, encodeId=1cb42023331d5, content=<a href='/topic/show?id=55d4889548b' target=_blank style='color:#2F92EE;'>#血压波动#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88954, encryptionId=55d4889548b, topicName=血压波动)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6ab940, createdName=hukaixun, createdTime=Mon Nov 20 10:16:00 CST 2017, time=2017-11-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2077267, encodeId=86b620e7267bc, content=<a href='/topic/show?id=2716535631' target=_blank style='color:#2F92EE;'>#CSP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=133, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5356, encryptionId=2716535631, topicName=CSP)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eq2AGzrugK9ZUjU3eJxzM901ophWib0xJDrSicy49ibWl3zB5pbDto7eoR6tnzwOiaKdbq1a8PcbYFFrw/132, createdBy=6ff22500098, createdName=ms4964546379600229, createdTime=Thu Apr 20 01:16:00 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1947520, encodeId=649f194e520b3, content=<a href='/topic/show?id=360f14591e2' target=_blank style='color:#2F92EE;'>#PPT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14591, encryptionId=360f14591e2, topicName=PPT)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/101296147/78FA0899509C358B01B975E8EAC1F88A/100, createdBy=7d822500145, createdName=ms5353107019656438, createdTime=Mon Feb 05 19:16:00 CST 2018, time=2018-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1267406, encodeId=0cab126e406f1, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Fri Mar 24 03:16:00 CST 2017, time=2017-03-24, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=2023331, encodeId=1cb42023331d5, content=<a href='/topic/show?id=55d4889548b' target=_blank style='color:#2F92EE;'>#血压波动#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88954, encryptionId=55d4889548b, topicName=血压波动)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6ab940, createdName=hukaixun, createdTime=Mon Nov 20 10:16:00 CST 2017, time=2017-11-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2077267, encodeId=86b620e7267bc, content=<a href='/topic/show?id=2716535631' target=_blank style='color:#2F92EE;'>#CSP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=133, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5356, encryptionId=2716535631, topicName=CSP)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eq2AGzrugK9ZUjU3eJxzM901ophWib0xJDrSicy49ibWl3zB5pbDto7eoR6tnzwOiaKdbq1a8PcbYFFrw/132, createdBy=6ff22500098, createdName=ms4964546379600229, createdTime=Thu Apr 20 01:16:00 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1947520, encodeId=649f194e520b3, content=<a href='/topic/show?id=360f14591e2' target=_blank style='color:#2F92EE;'>#PPT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14591, encryptionId=360f14591e2, topicName=PPT)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/101296147/78FA0899509C358B01B975E8EAC1F88A/100, createdBy=7d822500145, createdName=ms5353107019656438, createdTime=Mon Feb 05 19:16:00 CST 2018, time=2018-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1267406, encodeId=0cab126e406f1, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Fri Mar 24 03:16:00 CST 2017, time=2017-03-24, status=1, ipAttribution=)]
    2017-03-24 zhaohui6731

相关资讯

Hypertension:健康人血压受神经型一氧化氮合酶调节!

这些结果表明,nNOS来源的NO在健康人基础的全身血管阻力和血压的生理调节中发挥着重要作用。

Circulation:血压调节新机制

引起高血压的肾素血管紧张素系统(RAS)系统与升高的活性氧(ROS)产生相关。此前的研究表明在RAS激活期间,NADPH氧化酶(Nox)蛋白是ROS的重要来源,不同的Nox异构体可能涉及其中。其中,Nox2在多种细胞类型中表达,包括内皮细胞,成纤维细胞,免疫细胞和小胶质细胞。血压(BP)受中枢神经系统、肾脏和血管水平的调节,但是Nox2在BP调节中的细胞特异性作用尚未可知。近期,一项发表在杂志Ci

Circulation:积极控制血压对导管消融后心房颤动复发是否有益?

用于心房颤动的放射性导管消融已经成为AF的重要治疗方法,然而其复发率仍然很高。近期,一项发表在杂志Circulation上的研究旨在确定积极降低血压(BP)是否能够防止房颤(AF)患者进行导管消融后房颤的复发和高症状的负担。研究者们随机分配184例AF和BP大于130/80 mmHg的患者在进行AF导管消融术前进行强化BP治疗(目标<120/80 mm Hg)或标准BP治疗(目标<14

Diabetes Care:维格列汀和二甲双胍对小肠输注葡萄糖的2型糖尿病患者血压和心率的反应有啥影响?

由此可见,在2型糖尿病患者十二指肠葡萄糖输注过程中,维格列汀降低BP和增加HR,而二甲双胍增加HR,但并不影响BP。在肠内营养期间这些不同的心血管效应可能对餐后低血压有影响。

Am J Kidney Dis:持续性透析开始前血压及随后的死亡率有啥关系?

由此可见,较低的透析前SBP与透析开始前期高死亡率有关。透析前DBP与透析后的死亡率无关。需要进一步的研究来阐明透析患者理想的透析前SBP水平,以作为改善早期透析死亡率过高的一种手段。

Hypertension:妊娠并发症与将来发生高血压风险的关联

妊娠能增加心血管病的风险,但妊娠与高血压或血压之间是否有关联仍然未知。该研究联系瑞典北部瑞典医学生育登记中心,获取韦斯特伯顿干预项目数据,在15896名年龄在40岁、有怀孕史、没有孕前高血压的女性中,分析其妊娠史中与高血压或血压有关的妊娠因素。妊娠因素包括:分娩、头胎年龄、先兆子癫、妊娠糖尿病、胎盘早剥、体重小于出生体重的第三百分位数的最短胎龄儿、死胎等。