高血压患者血压控制与缺血性脑卒中发病风险的前瞻性队列研究

A prospective cohort study on blood pressure control and risk of ischemic stroke in patients with hypertension

目的探讨高血压患者血压控制与缺血性脑卒中发病风险的关联。方法于2010年4月至2011年9月采用两阶段抽样法从深圳市南山区8个街道101个社区中抽取60个社区的5488例高血压患者作为研究对象。收集对象的社会人口学特征、行为和生活方式、冠心病和糖尿病患病情况等资料(社区内居住≥6个月且年龄≥20岁)并进行体格、血压和血液生化指标测量。以2010年4月1日至2017年8月31日为随访期,按年度通过电话随访收集对象缺血性脑卒中发病情况。采用Cox比例风险回归模型分析血压控制、收缩压和舒张压与缺血性脑卒中发病风险的关联。结果研究对象年龄为(58.50±12.14)岁,其中男性2712例(49.42%),血压控制稳定者3112例(56.71%)。随访期内确诊缺血性脑卒中新发病例358例,发病密度为1346.27/10万人年。Cox比例风险回归模型分析显示,调整相关混杂因素后,血压控制不稳定、收缩压≥150 mmHg(1 mmHg=0.133 kPa;以收缩压<120 mmHg者为参照)和舒张压≥95 mmHg(以舒张压<80 mmHg者为参照)与缺血性脑卒中发病均有关联,HR(95%CI)值分别为1.29(1.04,1.59)、2.00(1.26,3.17)和1.52(1.01,2.64),性别亚组分析结果显示,以上关联仅存在于女性高血压患者中,HR(95%CI)值分别为:1.39(1.05,1.85)、2.53(1.41,4.56)和1.73(1.00,3.36)。结论血压控制不稳定增加女性高血压患者缺血性脑卒中发病风险。

Objective To explore the association between blood pressure control and risk of ischemic stroke(IS)in patients with hypertension.Methods A total of 5488 patients with hypertension from 60 communities were randomly selected from 101 communities in 8 streets of Nanshan District in Shenzhen City by using two‑stage sampling method.The social demographic characteristics,behavior and life style,coronary heart disease and diabetes were collected and the physical condition,blood pressure and blood biochemical indexes were measured.From April 1,2010 to August 31,2017 as the follow‑up period,the incidence of IS was annually collected by using telephone survey.Cox proportional hazard regression model was used to analyze the relationship between blood pressure control,systolic blood pressure(SBP),diastolic blood pressure(DBP)and the risk of IS.Results The age of all patients was(58.50±12.14)years old,including 2712 males(49.42%)and 3112 patients with well‑controlled blood pressure(56.71%).During the follow‑up period,358 new cases of IS were confirmed,and the incidence density was 1346.27/100000 person‑years.Cox proportional hazard regression model analysis showed after adjusting for confounding factors,unstable blood pressure control,SBP≥150 mmHg(1 mmHg=0.133 kPa;compared with SBP<120 mmHg),and DBP≥95 mmHg(compared with DBP<80 mmHg)were associated with risk of IS.The HR(95%CI)was 1.29(1.04,1.59),2.00(1.26,3.17)and 1.52(1.01,2.64),respectively.Subgroup analyses showed these associations only existed in female patients with hypertension.The HR(95%CI)was 1.39(1.05,1.85),2.53(1.41,4.56)and 1.73(1.00,3.36),respectively.Conclusion Unstable blood pressure control increases the risk of IS in female patients with hypertension.