Goal: The effect of pulse pressure and interactions with type of antihypertensive therapy on mortality after acute ischemic stroke has not been previously evaluated. Materials and Methods: A retrospective cohort study...Goal: The effect of pulse pressure and interactions with type of antihypertensive therapy on mortality after acute ischemic stroke has not been previously evaluated. Materials and Methods: A retrospective cohort study was conducted to evaluate the independent and interactive effects of pulse pressure and antihypertensive class (specifically angiotensin converting enzyme inhibitor/angiotensin type 1 receptor blocker, or beta blocker) on mortality following acute ischemic stroke. Findings/Conclusions: 343 patients were identified with 49 months of follow-up. Baseline pulse pressure was 64 mmHg and age was 66.5 years. Patients were divided at a pulse pressure of 70. Patients with pulse pressure ≥ 70 were older (p < 0.001) and had higher comorbid vascular burden (p = 0.031) than those with pulse pressure < 70. Pulse pressure did not remain a significant predictor of follow-up mortality after adjustment for baseline comorbidities. Angiotensin converting enzyme inhibitor/angiotensin type 1 receptor blocker based therapy was associated with lower follow-up mortality when beta blocker was not used in pulse pressure < 70 group (odds ratio 0.07, 95% confidence interval 0.01 - 0.48). Prospective analysis will be needed to confirm the protective effect of angiotensin converting enzyme inhibitor/angiotensin type 1 receptor blocker based on pulse pressure in acute ischemic stroke.展开更多
The importance of systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP), on the incidence of coronary heart disease (CHD) and stroke are known. However, the importance of blood pressur...The importance of systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP), on the incidence of coronary heart disease (CHD) and stroke are known. However, the importance of blood pressure (BP)-age shifts regarding the stroke incidence is not clearly known. The BP changes with the advancement of age from the predominance of DBP in the young to the predominance of SBP in the old. This change is due to the stiffening of the large arteries as a result of the aging process and the replacement of the elastic fibers with collagen fibers. This change results in the loss of compliance and the elastic recoil of these vessels leading to increase in pulse wave velocity, central SBP and widening of pulse pressure leading to an increased incidence of CHD and strokes. It has been demonstrated epidemiologically that the SBP rises linearly with age, whereas the DBP rises up to the age of 45-50 years, and then begins to decline after the age of 60 years leading to a progressive widening of PP. Several studies have shown an inverse relationship between DBP and CHD, whereas no such relationship has been demonstrated for stroke. However, a recent study showed an inverse relationship with DBP and stroke when it dropped below 71 mmHg in subjects 50 years of age or older. In contrast, there was a positive association between BP and stroke when both SBP and DBP were ≥ 71 mmHg. These findings suggest that intreating systolic hypertension in the elderly to reduce stroke risk, attention should be paid on the potential harm of low DBP and the widening of PP regarding CHD and stroke. The implications of BP shifts with age and the potential risks of low DBP regarding the risk of stroke will be discussed in this concise review.展开更多
Background:Arterial stiffening increases with age and blood pressure and is associated with cardiovascular disease(CVD),but the relationship between blood pressure lowering and arterial stiffening is still uncertain,e...Background:Arterial stiffening increases with age and blood pressure and is associated with cardiovascular disease(CVD),but the relationship between blood pressure lowering and arterial stiffening is still uncertain,especially in older people.This study aimed to evaluate the effect of intensive blood pressure treatment on the progression of arterial stiffness and risk of CVD in older patients with hypertension.Methods:The Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients(STEP)trial was a multicenter,randomized,controlled trial performed at 42 clinical centers throughout China,and 8511 patients aged 60-80 years with essential hypertension were enrolled and randomly assigned to systolic blood pressure(SBP)target of 110 mmHg to<130 mmHg(intensive treatment)or 130 mmHg to<150 mmHg(standard treatment).Patients underwent repeated examinations of the brachial-ankle pulse wave velocity(baPWV)and ankle-brachial index(ABI)at baseline,and the arterial stiffness was evaluated at the 3-year follow-up.A total of 5339 patients who had twice repeated measurements were included in this study.Changes in arterial stiffness between the intensive and standard treatment groups were analyzed using a multivariate linear regression model.The Cox proportional hazard regression model was used to evaluate the effect of intensive treatment on primary CVD outcomes.Results:The changes in baPWV were 61.5 cm/s(95%confidence interval[CI]:49.8-73.2 cm/s)in the intensive treatment group and 98.4 cm/s(95%CI:86.7-110.1 cm/s)in the standard treatment group(P<0.001).Intensive treatment significantly delayed the progression of arterial stiffness,with an annual change of 23.1 cm·s^(-1)·year-1 vs.36.7 cm·s^(-1)·year^(-1)of baPWV in the intensive and standard treatment groups,respectively.During a median follow-up period of 3.36 years,primary CVD outcomes occurred in 77(2.9%)patients in the intensive treatment group compared with 93(3.5%)in the standard treatment group.Intensive treatment resulted in a significantly lower CVD risk in patients aged 70-80 years or with SBP<140 mmHg.Conclusion:Intensive blood pressure control with an SBP target of 110 mmHg to<130 mmHg could delay the progression of arterial stiffness and reduce the risk of CVD in older patients with hypertension.Clinical trial registration:http://www.clinicaltrials.gov;No.NCT03015311.展开更多
目的:探讨分析不同脉压差水平高血压视网膜早期病变患者与颈动脉粥样硬化程度的相关性。方法:选择2021年10月至2022年5月深圳市福田区5个社康中心收治的183例高血压视网膜早期病变患者(即:眼底病变Ⅱ级以下患者),根据脉压差水平,将患者...目的:探讨分析不同脉压差水平高血压视网膜早期病变患者与颈动脉粥样硬化程度的相关性。方法:选择2021年10月至2022年5月深圳市福田区5个社康中心收治的183例高血压视网膜早期病变患者(即:眼底病变Ⅱ级以下患者),根据脉压差水平,将患者分为脉压差<7.98 k Pa(A组,95例)和脉压差≥7.98 kPa(B组,88例)。收集患者一般资料,采用超声检测患者颈总动脉内膜中层厚度(IMT)及颈内动脉阻力指数(RI)、舒张末期流速(EDV)、收缩峰值流速(PSV),两组患者均进行光相干断层扫描血管成像技术(OCTA)检查,获取血管密度(VD)、中心凹无血管区(FAZ)面积、FAZ周长、非圆度指数(AI);分析高血压视网膜早期病变患者颈动脉血流动力学参数与眼底病变参数的相关性;并对高血压视网膜早期病变患者颈动脉粥样硬化的影响因素进行单因素及多因素Logistic回归分析。结果:B组年龄、高血压病程、收缩压、舒张压、脉压差、低密度脂蛋白胆固醇(LDL-C)显著高于A组,高密度脂蛋白胆固醇(HDL-C)、PSV显著低于A组(P<0.05)。A组与B组颈动脉正常、增厚、斑块形成、狭窄患者比例差异有统计学意义(P<0.05),其中B组颈动脉狭窄患者比例显著较高。单因素Logistic回归分析结果中年龄、高血压病程、脉压差与高血压视网膜早期病变患者颈动脉粥样硬化有关(P<0.05)。多因素Logistic回归分析结果中脉压差≥7.98 kPa是高血压视网膜早期病变患者发生颈动脉粥样硬化的危险因素(P<0.05)。结论:脉压差水平与高血压视网膜早期病变患者颈动脉粥样硬化密切相关,可为评估预测患者颈动脉粥样硬化程度提供一定参考依据。展开更多
文摘Goal: The effect of pulse pressure and interactions with type of antihypertensive therapy on mortality after acute ischemic stroke has not been previously evaluated. Materials and Methods: A retrospective cohort study was conducted to evaluate the independent and interactive effects of pulse pressure and antihypertensive class (specifically angiotensin converting enzyme inhibitor/angiotensin type 1 receptor blocker, or beta blocker) on mortality following acute ischemic stroke. Findings/Conclusions: 343 patients were identified with 49 months of follow-up. Baseline pulse pressure was 64 mmHg and age was 66.5 years. Patients were divided at a pulse pressure of 70. Patients with pulse pressure ≥ 70 were older (p < 0.001) and had higher comorbid vascular burden (p = 0.031) than those with pulse pressure < 70. Pulse pressure did not remain a significant predictor of follow-up mortality after adjustment for baseline comorbidities. Angiotensin converting enzyme inhibitor/angiotensin type 1 receptor blocker based therapy was associated with lower follow-up mortality when beta blocker was not used in pulse pressure < 70 group (odds ratio 0.07, 95% confidence interval 0.01 - 0.48). Prospective analysis will be needed to confirm the protective effect of angiotensin converting enzyme inhibitor/angiotensin type 1 receptor blocker based on pulse pressure in acute ischemic stroke.
文摘The importance of systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP), on the incidence of coronary heart disease (CHD) and stroke are known. However, the importance of blood pressure (BP)-age shifts regarding the stroke incidence is not clearly known. The BP changes with the advancement of age from the predominance of DBP in the young to the predominance of SBP in the old. This change is due to the stiffening of the large arteries as a result of the aging process and the replacement of the elastic fibers with collagen fibers. This change results in the loss of compliance and the elastic recoil of these vessels leading to increase in pulse wave velocity, central SBP and widening of pulse pressure leading to an increased incidence of CHD and strokes. It has been demonstrated epidemiologically that the SBP rises linearly with age, whereas the DBP rises up to the age of 45-50 years, and then begins to decline after the age of 60 years leading to a progressive widening of PP. Several studies have shown an inverse relationship between DBP and CHD, whereas no such relationship has been demonstrated for stroke. However, a recent study showed an inverse relationship with DBP and stroke when it dropped below 71 mmHg in subjects 50 years of age or older. In contrast, there was a positive association between BP and stroke when both SBP and DBP were ≥ 71 mmHg. These findings suggest that intreating systolic hypertension in the elderly to reduce stroke risk, attention should be paid on the potential harm of low DBP and the widening of PP regarding CHD and stroke. The implications of BP shifts with age and the potential risks of low DBP regarding the risk of stroke will be discussed in this concise review.
基金supported by grants from the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(Nos.2016-I2M-1-006 and 2021-I2M-1-011)
文摘Background:Arterial stiffening increases with age and blood pressure and is associated with cardiovascular disease(CVD),but the relationship between blood pressure lowering and arterial stiffening is still uncertain,especially in older people.This study aimed to evaluate the effect of intensive blood pressure treatment on the progression of arterial stiffness and risk of CVD in older patients with hypertension.Methods:The Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients(STEP)trial was a multicenter,randomized,controlled trial performed at 42 clinical centers throughout China,and 8511 patients aged 60-80 years with essential hypertension were enrolled and randomly assigned to systolic blood pressure(SBP)target of 110 mmHg to<130 mmHg(intensive treatment)or 130 mmHg to<150 mmHg(standard treatment).Patients underwent repeated examinations of the brachial-ankle pulse wave velocity(baPWV)and ankle-brachial index(ABI)at baseline,and the arterial stiffness was evaluated at the 3-year follow-up.A total of 5339 patients who had twice repeated measurements were included in this study.Changes in arterial stiffness between the intensive and standard treatment groups were analyzed using a multivariate linear regression model.The Cox proportional hazard regression model was used to evaluate the effect of intensive treatment on primary CVD outcomes.Results:The changes in baPWV were 61.5 cm/s(95%confidence interval[CI]:49.8-73.2 cm/s)in the intensive treatment group and 98.4 cm/s(95%CI:86.7-110.1 cm/s)in the standard treatment group(P<0.001).Intensive treatment significantly delayed the progression of arterial stiffness,with an annual change of 23.1 cm·s^(-1)·year-1 vs.36.7 cm·s^(-1)·year^(-1)of baPWV in the intensive and standard treatment groups,respectively.During a median follow-up period of 3.36 years,primary CVD outcomes occurred in 77(2.9%)patients in the intensive treatment group compared with 93(3.5%)in the standard treatment group.Intensive treatment resulted in a significantly lower CVD risk in patients aged 70-80 years or with SBP<140 mmHg.Conclusion:Intensive blood pressure control with an SBP target of 110 mmHg to<130 mmHg could delay the progression of arterial stiffness and reduce the risk of CVD in older patients with hypertension.Clinical trial registration:http://www.clinicaltrials.gov;No.NCT03015311.
文摘目的:探讨分析不同脉压差水平高血压视网膜早期病变患者与颈动脉粥样硬化程度的相关性。方法:选择2021年10月至2022年5月深圳市福田区5个社康中心收治的183例高血压视网膜早期病变患者(即:眼底病变Ⅱ级以下患者),根据脉压差水平,将患者分为脉压差<7.98 k Pa(A组,95例)和脉压差≥7.98 kPa(B组,88例)。收集患者一般资料,采用超声检测患者颈总动脉内膜中层厚度(IMT)及颈内动脉阻力指数(RI)、舒张末期流速(EDV)、收缩峰值流速(PSV),两组患者均进行光相干断层扫描血管成像技术(OCTA)检查,获取血管密度(VD)、中心凹无血管区(FAZ)面积、FAZ周长、非圆度指数(AI);分析高血压视网膜早期病变患者颈动脉血流动力学参数与眼底病变参数的相关性;并对高血压视网膜早期病变患者颈动脉粥样硬化的影响因素进行单因素及多因素Logistic回归分析。结果:B组年龄、高血压病程、收缩压、舒张压、脉压差、低密度脂蛋白胆固醇(LDL-C)显著高于A组,高密度脂蛋白胆固醇(HDL-C)、PSV显著低于A组(P<0.05)。A组与B组颈动脉正常、增厚、斑块形成、狭窄患者比例差异有统计学意义(P<0.05),其中B组颈动脉狭窄患者比例显著较高。单因素Logistic回归分析结果中年龄、高血压病程、脉压差与高血压视网膜早期病变患者颈动脉粥样硬化有关(P<0.05)。多因素Logistic回归分析结果中脉压差≥7.98 kPa是高血压视网膜早期病变患者发生颈动脉粥样硬化的危险因素(P<0.05)。结论:脉压差水平与高血压视网膜早期病变患者颈动脉粥样硬化密切相关,可为评估预测患者颈动脉粥样硬化程度提供一定参考依据。
