Neurology:脑出血(ICH)幸存者控压追踪:ICH发生后血压控制受先前高血压严重程度与社会经济状况深刻影响!

2022-03-06 Naomi MedSci原创

近日,研究人员使用潜在类别分析(LCA)调查了脑出血(ICH)前后高血压严重程度变化,并确定可预测个体血压轨迹的患者特征。大多数ICH幸存者在卒中后的高血压严重程度并没有持续改善,受患者特征深刻影响。

      超过一半的脑出血(ICH)幸存者在急性出血后5年内再次脑出血或功能损害。血压管理是脑出血后二级预防的基石,血压降低与再次脑出血、痴呆和功能衰退的风险降低有关。然而,只有不到一半的ICH幸存者达到了推荐的治疗目标。急性脑出血后高血压控制存在种族/民族差异,当前对ICH中血压控制不足的生物和社会因素的洞察力仍非常有限。

      研究者假设长期(即出血前)高血压的严重程度可能是解释脑出血后血压控制不良的关键因素。近日,有研究者利用了在马萨诸塞州综合医院(MGH)进行的关于ICH的单中心、持续的纵向研究的数据。试图使用一种无偏见的生物信息学方法(潜在类别分析,LCA)分析了脑出血后和脑出血前高血压严重程度的时间轨迹,使研究人员能够识别在疾病危险因素或表现上有相似之处的患者亚组。

      研究者分析了2002年至2019年在波士顿(美国马萨诸塞州)马萨诸塞州总医院(MGH)进行的一项研究中登记的ICH幸存者的数据,波士顿是一个资源丰富的环境,几乎覆盖了全民的医疗保险。采集了急性脑出血住院前后12个月的血压测量结果。使用LCA,以一种公正的方式,根据高血压严重程度随时间的变化确定患者组(类)。然后创建了多项Logistic回归模型,以确定与这些类别相关的患者因素。

  • 在336名参与者中,平均年龄为74.4岁,其中166人(49%)为男性,288人(86%)自报白人种族/民族。
  • LCA确定了三类患者,分别对应于脑出血后高血压严重程度的轻微改善(n=114,34%)、中度改善(n=128,38%)和实质性改善(n=94,28%)。
  • 脑出血前高血压治疗不足(相对风险比(RRR)0.05,95%可信区间(CI)0.01-0.23)或高血压抵抗(RRR 0.03,95%CI 0.01-0.06)的幸存者在脑出血后不太可能经历实质性改善。
  • 高收入社区的居民更有可能经历实质性的改善(每10,000美元的RRR为1.14,95%CI为1.02-1.28)。
  • 在脑出血前高血压未得到控制的黑人、西班牙裔和亚洲参与者在出血性卒中后更有可能经历微小的改善(交互作用p<0.001)。

      与出血性卒中前相比,大多数脑出血幸存者在出血性卒中后的高血压严重程度并没有持续改善。脑出血后血压控制受出血前患者特征(主要是卒中前高血压严重程度和社会经济状况)的深刻影响。值得注意的是,在几乎全民医疗覆盖的高资源环境中,社区收入与脑出血后高血压的严重程度相关。此外,这些发现可能导致先前文献记载的脑出血后在血压控制和临床结果方面的种族/民族差异。

文献来源:Abramson JR, Castello JP, Keins S, et al. Biological and Social Determinants of Hypertension Severity Before vs After Intracerebral Hemorrhage [published online ahead of print, 2022 Feb 7]. Neurology. 2022;10.1212/WNL.0000000000200003. doi:10.1212/WNL.0000000000200003

 

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[GetPortalCommentsPageByObjectIdResponse(id=1924514, encodeId=d4a9192451495, content=<a href='/topic/show?id=a7f2e3997c4' target=_blank style='color:#2F92EE;'>#社会经济#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73997, encryptionId=a7f2e3997c4, topicName=社会经济)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=医者仁心, createdTime=Mon Jun 06 03:45:31 CST 2022, time=2022-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635992, encodeId=335f1635992ba, content=<a href='/topic/show?id=00f5e400787' target=_blank style='color:#2F92EE;'>#社会经济状况#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74007, encryptionId=00f5e400787, topicName=社会经济状况)], attachment=null, authenticateStatus=null, createdAvatar=null, 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topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Wed Jul 20 01:45:31 CST 2022, time=2022-07-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199864, encodeId=2682119986415, content=临床医学plus社会经济学, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210127/50a003c4097845e182c08afd64d8a509/bd766dfebe9c40e0bca2dae964601bdc.jpg, createdBy=22de5454917, createdName=carrotlyl, createdTime=Sun Mar 06 10:46:29 CST 2022, time=2022-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199883, encodeId=b0001199883c0, content=学习了。近期连续遇到几个病患出现这样的情况,原因很多,多谢多谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7ac21817490, createdName=ms3374847567989349, createdTime=Sun Mar 06 11:50:22 CST 2022, time=2022-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199842, encodeId=3cea119984223, content=医学与社会学, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210512/b39c8bc0ab334969ba4ccc08e7a6cd94/c4e41798ef27449aa31ad740c9b13062.jpg, createdBy=5ff35133022, createdName=forvalen, createdTime=Sun Mar 06 09:37:58 CST 2022, time=2022-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199821, encodeId=89631199821fd, content=学习~, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfb41991958, createdName=xulv123, createdTime=Sun Mar 06 08:08:52 CST 2022, time=2022-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199800, encodeId=02b41199800d7, content=血压控制与收入有关, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d1e05489924, createdName=ms1000002136354097, createdTime=Sun Mar 06 02:00:31 CST 2022, time=2022-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1316391, encodeId=ca44131639155, content=<a href='/topic/show?id=f3789349c3' target=_blank style='color:#2F92EE;'>#ICH#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9349, encryptionId=f3789349c3, topicName=ICH)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c192448, createdName=diushouji, createdTime=Thu Mar 03 10:45:31 CST 2022, time=2022-03-03, status=1, ipAttribution=)]
    2022-07-20 yinhl1978
  5. [GetPortalCommentsPageByObjectIdResponse(id=1924514, encodeId=d4a9192451495, content=<a href='/topic/show?id=a7f2e3997c4' target=_blank style='color:#2F92EE;'>#社会经济#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73997, encryptionId=a7f2e3997c4, topicName=社会经济)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=医者仁心, createdTime=Mon Jun 06 03:45:31 CST 2022, time=2022-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635992, encodeId=335f1635992ba, content=<a href='/topic/show?id=00f5e400787' target=_blank style='color:#2F92EE;'>#社会经济状况#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74007, encryptionId=00f5e400787, topicName=社会经济状况)], attachment=null, authenticateStatus=null, createdAvatar=null, 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topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Wed Jul 20 01:45:31 CST 2022, time=2022-07-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199864, encodeId=2682119986415, content=临床医学plus社会经济学, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210127/50a003c4097845e182c08afd64d8a509/bd766dfebe9c40e0bca2dae964601bdc.jpg, createdBy=22de5454917, createdName=carrotlyl, createdTime=Sun Mar 06 10:46:29 CST 2022, time=2022-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199883, encodeId=b0001199883c0, content=学习了。近期连续遇到几个病患出现这样的情况,原因很多,多谢多谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7ac21817490, createdName=ms3374847567989349, createdTime=Sun Mar 06 11:50:22 CST 2022, time=2022-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199842, encodeId=3cea119984223, content=医学与社会学, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210512/b39c8bc0ab334969ba4ccc08e7a6cd94/c4e41798ef27449aa31ad740c9b13062.jpg, createdBy=5ff35133022, createdName=forvalen, createdTime=Sun Mar 06 09:37:58 CST 2022, time=2022-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199821, encodeId=89631199821fd, content=学习~, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfb41991958, createdName=xulv123, createdTime=Sun Mar 06 08:08:52 CST 2022, time=2022-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199800, encodeId=02b41199800d7, content=血压控制与收入有关, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d1e05489924, createdName=ms1000002136354097, createdTime=Sun Mar 06 02:00:31 CST 2022, time=2022-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1316391, encodeId=ca44131639155, content=<a href='/topic/show?id=f3789349c3' target=_blank style='color:#2F92EE;'>#ICH#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9349, encryptionId=f3789349c3, topicName=ICH)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c192448, createdName=diushouji, createdTime=Thu Mar 03 10:45:31 CST 2022, time=2022-03-03, status=1, ipAttribution=)]
    2022-03-06 carrotlyl

    临床医学plus社会经济学

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1924514, encodeId=d4a9192451495, content=<a href='/topic/show?id=a7f2e3997c4' target=_blank style='color:#2F92EE;'>#社会经济#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73997, encryptionId=a7f2e3997c4, topicName=社会经济)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=医者仁心, createdTime=Mon Jun 06 03:45:31 CST 2022, time=2022-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635992, encodeId=335f1635992ba, content=<a href='/topic/show?id=00f5e400787' target=_blank style='color:#2F92EE;'>#社会经济状况#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74007, encryptionId=00f5e400787, topicName=社会经济状况)], attachment=null, authenticateStatus=null, createdAvatar=null, 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7ac21817490, createdName=ms3374847567989349, createdTime=Sun Mar 06 11:50:22 CST 2022, time=2022-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199842, encodeId=3cea119984223, content=医学与社会学, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210512/b39c8bc0ab334969ba4ccc08e7a6cd94/c4e41798ef27449aa31ad740c9b13062.jpg, createdBy=5ff35133022, createdName=forvalen, createdTime=Sun Mar 06 09:37:58 CST 2022, time=2022-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199821, encodeId=89631199821fd, content=学习~, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfb41991958, createdName=xulv123, createdTime=Sun Mar 06 08:08:52 CST 2022, time=2022-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199800, encodeId=02b41199800d7, content=血压控制与收入有关, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d1e05489924, createdName=ms1000002136354097, createdTime=Sun Mar 06 02:00:31 CST 2022, time=2022-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1316391, encodeId=ca44131639155, content=<a href='/topic/show?id=f3789349c3' target=_blank style='color:#2F92EE;'>#ICH#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9349, encryptionId=f3789349c3, topicName=ICH)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c192448, createdName=diushouji, createdTime=Thu Mar 03 10:45:31 CST 2022, time=2022-03-03, status=1, ipAttribution=)]
    2022-03-06 ms3374847567989349

    学习了。近期连续遇到几个病患出现这样的情况,原因很多,多谢多谢

    0

  7. 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topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Wed Jul 20 01:45:31 CST 2022, time=2022-07-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199864, encodeId=2682119986415, content=临床医学plus社会经济学, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210127/50a003c4097845e182c08afd64d8a509/bd766dfebe9c40e0bca2dae964601bdc.jpg, createdBy=22de5454917, createdName=carrotlyl, createdTime=Sun Mar 06 10:46:29 CST 2022, time=2022-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199883, encodeId=b0001199883c0, content=学习了。近期连续遇到几个病患出现这样的情况,原因很多,多谢多谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7ac21817490, createdName=ms3374847567989349, createdTime=Sun Mar 06 11:50:22 CST 2022, time=2022-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199842, encodeId=3cea119984223, content=医学与社会学, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210512/b39c8bc0ab334969ba4ccc08e7a6cd94/c4e41798ef27449aa31ad740c9b13062.jpg, createdBy=5ff35133022, createdName=forvalen, createdTime=Sun Mar 06 09:37:58 CST 2022, time=2022-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199821, encodeId=89631199821fd, content=学习~, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfb41991958, createdName=xulv123, createdTime=Sun Mar 06 08:08:52 CST 2022, time=2022-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199800, encodeId=02b41199800d7, content=血压控制与收入有关, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d1e05489924, createdName=ms1000002136354097, createdTime=Sun Mar 06 02:00:31 CST 2022, time=2022-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1316391, encodeId=ca44131639155, content=<a href='/topic/show?id=f3789349c3' target=_blank style='color:#2F92EE;'>#ICH#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9349, encryptionId=f3789349c3, topicName=ICH)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c192448, createdName=diushouji, createdTime=Thu Mar 03 10:45:31 CST 2022, time=2022-03-03, status=1, ipAttribution=)]
    2022-03-06 forvalen

    医学与社会学

    0

  8. 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    2022-03-06 xulv123

    学习~

    0

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    2022-03-06 ms1000002136354097

    血压控制与收入有关

    0

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    2022-03-03 diushouji

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