Abstract:

Objective To assess the J shaped curve between the value of blood pressure and the occurrence of stroke in the antihypertension treatment. Methods A retrospective analysis was conducted in the 2059 patients accepted antihypertension treatment in outpatients or hospitalized from January 2009 to October 2013. The restricted cubic spline (RCS) fitting Cox regression model was used to evaluate the relationship between different blood pressure cut-off value and stroke. The Kaplan-Meier methods was used to assess the incidence of stroke during follow-up, and Cox proportion risk model was used to analyze the independent risk factors for stroke. Results The 1, 3, 5 year cumulative stroke incidence rates in the whole patients were 2.5%, 8.8% and 16.6%, respectively. There existed a nonlinear relationship between blood pressure value and the occurrence of stroke assessed by the RCS fitting Cox model. The risk rates for stroke increased in the patients whose systolic blood pressure (SBP) <110 mmHg or >150 mmHg and diastolic blood pressure (DBP) <60 mmHg or >90 mmHg. The Cox proportional hazard model by multivariate analysis found that smoking history (HR 2.32, 95%CI 1.36-3.13, P =0.009), diabetes (HR 2.07, 95%CI 1.18-3.05, P =0.011), atrial fibrillation (HR 1.89, 95%CI 1.16-2.98, P =0.014), SBP < 110 mmHg (HR 1.62, 95%CI 1.11-2.24, P =0.032) or >150 mmHg (HR 1.79, 95%CI 1.21- 2.72, P =0.013) and carotid artery stenosis (HR 2.47, 95%CI 1.37-4.18, P =0.008) were independent factors for stroke. Conclusion There existed the J shaped curve between blood pressure and stroke in the course of antihypertensive treatment. The incidence of stroke increased in the patients of SBP <110 mmHg or >150 mmHg.

Key words: Hypertension; Stroke; J shaped curve; Restricted cubic spline

摘要：

目的 评估抗高血压治疗中血压值与卒中的发生是否存在J型曲线。 方法 回顾性分析2009年1月-2013年10月于门诊或住院接受治疗的2059例高血压患者，采用限制 性立方样条（restricted cubic spline，RCS）拟合Cox回归模型来评估不同的血压截点与卒中的关系，用 Kaplan-Meier法评估随访期间卒中的发生率，Cox比例风险模型分析影响卒中的独立危险因素。 结果 总体患者1、3、5年累积卒中发生率分别为2.5%、8.8%和16.6%。经RCS拟合Cox模型评估，发 现血压值与是否发生卒中呈非线性关系，对于收缩压（systolic blood pressure，SBP）＜110 mmHg或＞ 150 mmHg的患者，以及舒张压（diastolic blood pressure，DBP）＜60 mmHg或＞90 mmHg的患者，卒中的 发生风险增加。经Cox风险比例模型多因素分析，吸烟史（HR 2.32，95%CI 1.36～3.13，P =0.009）、 糖尿病（HR 2.07，95%CI 1.18～3.05，P =0.011）、心房颤动（HR 1.89，95%CI 1.16～2.98，P =0.014）、 SBP＜110 mmHg（HR 1.62，95%CI 1.11～2.24，P =0.032）或＞150 mmHg（HR 1.79，95%CI 1.21～2.72， P =0.013）和颈动脉狭窄（HR 2.47，95%CI 1.37～4.18，P =0.008）是卒中的独立危险因素。 结论 抗高血压治疗中，存在血压值与卒中的J型曲线现象；SBP＜110 mmHg或＞150 mmHg的患者，卒 中的发生风险增加。

关键词: 高血压; 卒中; J型曲线; 限制性立方样条