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Effect of Low Diastolic Blood Pressure to Cardiovascular Risk in Patients With Ischemic Stroke or Transient Ischemic Attacks Under Different Systolic Blood Pressure Levels.
Frontiers in Neurology ( IF 2.7 ) Pub Date : 2020-05-27 , DOI: 10.3389/fneur.2020.00356 Zimo Chen 1, 2, 3, 4 , Jinglin Mo 1, 2, 3, 4 , Jie Xu 1, 2, 3, 4 , Liye Dai 1, 2, 3, 4 , Aichun Cheng 1, 2, 3, 4 , Gulbahram Yalkun 1, 2, 3, 4 , Anxin Wang 1, 2, 3, 4 , Xia Meng 1, 2, 3, 4 , Hao Li 1, 2, 3, 4 , Yongjun Wang 1, 2, 3, 4
Frontiers in Neurology ( IF 2.7 ) Pub Date : 2020-05-27 , DOI: 10.3389/fneur.2020.00356 Zimo Chen 1, 2, 3, 4 , Jinglin Mo 1, 2, 3, 4 , Jie Xu 1, 2, 3, 4 , Liye Dai 1, 2, 3, 4 , Aichun Cheng 1, 2, 3, 4 , Gulbahram Yalkun 1, 2, 3, 4 , Anxin Wang 1, 2, 3, 4 , Xia Meng 1, 2, 3, 4 , Hao Li 1, 2, 3, 4 , Yongjun Wang 1, 2, 3, 4
Affiliation
Background: In the context of recently updated strategies of pressure management, there is a paucity of evidence on the effect of diastolic blood pressure (DBP) level on adverse events among stroke patients. This study aimed to examine the effect of low DBP (<60 mmHg) under different levels of systolic blood pressure (SBP) on the risk of composite events and stroke recurrence among patients with ischemic stroke (IS) or transient ischemic attack (TIA). Material and Methods: This study was conducted in 2,325 patients with IS or TIA. DBP values were categorized into <60, 60-70, 70-80 (reference), 80-90, and ≥90 mmHg in the main sample and were further categorized as <60 and ≥60 mmHg (reference) when patients were stratified according to SBP levels (<140, <130, and <120 mmHg). The outcomes were defined as recurrent stroke and cumulative composite events (defined as the combination of nonfatal myocardial infarction, nonfatal congestive heart failure, and death) at 1 year. Results: During 1 year of follow-up, a total of 95 composite events and 138 stroke recurrences were identified. The patients with low DBP showed a significantly higher risk of composite events [hazard ratio (HR) = 4.86, 95% confidence interval (CI) = 2.54-8.52], especially the elderly patients (≥60 years); however, this result was not observed for stroke recurrence (HR = 0.90, 95% CI = 0.46-1.74). With the reduction of the SBP levels, the proportion of patients with low DBP increased (6.87, 12.67, and 34.46%), and the risk for composite events persisted. Conclusions: Along with the new target levels of SBP suggested by updated criteria, there is a trend for DBP to be reduced to a harmfully low level, which was associated with an increased risk of composite events among patients with IS or TIA.
中文翻译：
低舒张压对不同收缩压水平下缺血性卒中或短暂性脑缺血发作患者心血管风险的影响。
背景：在最近更新的压力管理策略的背景下，缺乏证据表明舒张压（DBP）水平对中风患者不良事件的影响。这项研究旨在探讨在不同水平的收缩压（SBP）下低DBP（<60 mmHg）对缺血性中风（IS）或短暂性脑缺血发作（TIA）患者发生复合事件和中风复发的风险。材料和方法：本研究在2,325例IS或TIA患者中进行。在主要样本中，DBP值分为<60、60-70、70-80（参考），80-90和≥90mmHg，并在根据患者进行分层时进一步分为<60和≥60mmHg（参考）。达到SBP水平（<140，<130和<120 mmHg）。结果定义为1年时复发性中风和累积性复合事件（定义为非致命性心肌梗塞，非致命性充血性心力衰竭和死亡的组合）。结果：在随访的1年中，共鉴定出95例复合事件和138例中风复发。低DBP患者表现出明显更高的复合事件风险[危险比（HR）= 4.86，95％置信区间（CI）= 2.54-8.52]，尤其是老年患者（≥60岁）；但是，卒中复发未观察到该结果（HR = 0.90，95％CI = 0.46-1.74）。随着SBP水平的降低，低DBP患者的比例增加（6.87、12.67和34.46％），并且持续发生复合事件的风险仍然存在。结论：除了更新标准提出的新的SBP目标水平外，
更新日期：2020-05-27
中文翻译：
低舒张压对不同收缩压水平下缺血性卒中或短暂性脑缺血发作患者心血管风险的影响。
背景：在最近更新的压力管理策略的背景下，缺乏证据表明舒张压（DBP）水平对中风患者不良事件的影响。这项研究旨在探讨在不同水平的收缩压（SBP）下低DBP（<60 mmHg）对缺血性中风（IS）或短暂性脑缺血发作（TIA）患者发生复合事件和中风复发的风险。材料和方法：本研究在2,325例IS或TIA患者中进行。在主要样本中，DBP值分为<60、60-70、70-80（参考），80-90和≥90mmHg，并在根据患者进行分层时进一步分为<60和≥60mmHg（参考）。达到SBP水平（<140，<130和<120 mmHg）。结果定义为1年时复发性中风和累积性复合事件（定义为非致命性心肌梗塞，非致命性充血性心力衰竭和死亡的组合）。结果：在随访的1年中，共鉴定出95例复合事件和138例中风复发。低DBP患者表现出明显更高的复合事件风险[危险比（HR）= 4.86，95％置信区间（CI）= 2.54-8.52]，尤其是老年患者（≥60岁）；但是，卒中复发未观察到该结果（HR = 0.90，95％CI = 0.46-1.74）。随着SBP水平的降低，低DBP患者的比例增加（6.87、12.67和34.46％），并且持续发生复合事件的风险仍然存在。结论：除了更新标准提出的新的SBP目标水平外，
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