Association of Systolic Blood Pressure with Progression of Symptomatic Intracranial Atherosclerotic Stenosis
2
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
Background and Purpose Elevated blood pressure (BP) is associated with greater severity of intracranial atherosclerotic stenosis (ICAS) and increased risk of ischemic stroke. Because little is known about the relationship of maintained BP level with progression of symptomatic ICAS (sICAS), we evaluated the independent association of maintained systolic BP (SBP) with risk of sICAS progression. Methods We analyzed the Trial of cilOstazol in Symptomatic intracranial Stenosis 2, which evaluated 402 stroke patients with sICAS (mean age, 64.5±11.3 years; male, 52.2%). Study participants were categorized into four groups according to mean SBP level: low-normal (<120 mm Hg), normal to high-normal (120 to 139 mmHg), high (140 to 159 mm Hg), and very-high (≥160 mm Hg). Progression of sICAS was defined as worsening in the degree of stenosis by ≥1 grade on the 7-month magnetic resonance angiography follow-up. Results sICAS progression was observed in 52 (12.9%) subjects. Percentages of sICAS progression by mean SBP category showed a J-shape pattern: low-normal (21.4%), normal to high-normal (10.7%), high (11.4%), and very-high (38.9%). In multivariable analysis, compared to the normal to high-normal SBP group, odds ratios (95% confidence intervals) were low-normal, 1.88 (0.62–5.67); high, 1.06 (0.47–2.37); and very-high, 8.75 (2.57–29.86). Rate of sICAS progression by 10-mm Hg strata showed a similar pattern to findings from mean SBP category (9.47; 2.58–34.73 for SBP ≥160 mm Hg). Conclusions Among individuals with a recent ICAS stroke, very-high SBP level during the short-term period after the index stroke was associated with significantly greater odds of sICAS progression.
Abstract
Background and Purpose Elevated blood pressure (BP) is associated with greater severity of intracranial atherosclerotic stenosis (ICAS) and increased risk of ischemic stroke. Because little is known about the relationship of maintained BP level with progression of symptomatic ICAS (sICAS), we evaluated the independent association of maintained systolic BP (SBP) with risk of sICAS progression. Methods We analyzed the Trial of cilOstazol in Symptomatic intracranial Stenosis 2, which evaluated 402 stroke patients with sICAS (mean age, 64.5±11.3 years; male, 52.2%). Study participants were categorized into four groups according to mean SBP level: low-normal (<120 mm Hg), normal to high-normal (120 to 139 mmHg), high (140 to 159 mm Hg), and very-high (≥160 mm Hg). Progression of sICAS was defined as worsening in the degree of stenosis by ≥1 grade on the 7-month magnetic resonance angiography follow-up. Results sICAS progression was observed in 52 (12.9%) subjects. Percentages of sICAS progression by mean SBP category showed a J-shape pattern: low-normal (21.4%), normal to high-normal (10.7%), high (11.4%), and very-high (38.9%). In multivariable analysis, compared to the normal to high-normal SBP group, odds ratios (95% confidence intervals) were low-normal, 1.88 (0.62–5.67); high, 1.06 (0.47–2.37); and very-high, 8.75 (2.57–29.86). Rate of sICAS progression by 10-mm Hg strata showed a similar pattern to findings from mean SBP category (9.47; 2.58–34.73 for SBP ≥160 mm Hg). Conclusions Among individuals with a recent ICAS stroke, very-high SBP level during the short-term period after the index stroke was associated with significantly greater odds of sICAS progression.
참고문헌 (17)
- Wong LK, "Global burden of intracranial atherosclerosis", Int J Stroke, 1, pp.158~159 (2006)
- Gorelick PB, "Large artery intracranial occlusive disease: a large worldwide burden but a relatively neglected frontier", Stroke, 39, pp.2396~2399 (2008)
- Holmstedt CA, "Atherosclerotic intracranial arterial stenosis: risk factors, diagnosis, and treatment", Lancet Neurol, 12, pp.1106~1114 (2013)
- Arenillas JF, "Progression and clinical recurrence of symptomatic middle cerebral artery stenosis: a long-term follow-up transcranial doppler ultrasound study", Stroke, 32, pp.2898~2904 (2001)
- Wong KS, "Progression of middle cerebral artery occlusive disease and its relationship with further vascular events after stroke", Stroke, 33, pp.532~536 (2002)
- Kasner SE, "Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis", Circulation, 113, pp.555~563 (2006)
- Turan TN, "Relationship between blood pressure and stroke recurrence in patients with intracranial arterial stenosis", Circulation, 115, pp.2969~2975 (2007)
- Rothwell PM, "Relationship between blood pressure and stroke risk in patients with symptomatic carotid occlusive disease", Stroke, 34, pp.2583~2590 (2003)
- Sutton-Tyrrell K, "Blood pressure treatment slows the progression of carotid stenosis in patients with isolated systolic hypertension", Stroke, 25, pp.44~50 (1994)
- Reed DM, "A prospective study of cerebral artery atherosclerosis", Stroke, 19, pp.820~825 (1988)
- Kwon SU, "Efficacy and safety of combination antiplatelet therapies in patients with symptomatic intracranial atherosclerotic stenosis", Stroke, 42, pp.2883~2890 (2011)
- Chobanian AV, "The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report", JAMA, 289, pp.2560~2572 (2003)
- Ovbiagele B, "Level of systolic blood pressure within the normal range and risk of recurrent stroke", JAMA, 306, pp.2137~2144 (2011)
- Lemeshow S, "A review of goodness of fit statistics for use in the development of logistic regression models", Am J Epidemiol, 115, pp.92~106 (1982)
- Leung TW, "Evolution of intracranial atherosclerotic disease under modern medical therapy", Ann Neurol, 77, pp.478~486 (2015)
- Chaturvedi S, "Risk factor status and vascular events in patients with symptomatic intracranial stenosis", Neurology, 69, pp.2063~2068 (2007)
- Chimowitz MI, "Stenting versus aggressive medical therapy for intracranial arterial stenosis", N Engl J Med, 365, pp.993~1003 (2011)