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JAHA:加强对血压升高的处理与卒中复发风险的关系

2021-03-31 MedSci原创 MedSci原创

低TI评分意味着医生在患者血压管理方面存在治疗惰性,与卒中复发的高风险相关。TI评分可能是门诊一个有用的指标,以防止卒中复发。

目前,医生对及时处理血压升高的态度是否会影响卒中复发的风险尚未明确。

近日,血管疾病领域权威杂志JAHA上发表了一篇研究文章,研究人员从一个多中心卒中登记数据库中确定了2933名急性缺血性卒中患者,他们于2011年入住参与中心,并在随访1年后仍存活,且出院后随诊2次以上。

作为医生态度的替代指标-个体治疗强化(TI)评分是通过将观察到的和预期的药物改变频率除以门诊就诊次数的差值来衡量的,并将其分为5组。研究人员使用分级脆弱模型分析了TI组别与1年内卒中复发之间的关系,并对各医院的聚类和相关协变量进行了调整。

TI评分的平均值±SD为-0.13±0.28。与第3组相比,TI评分组卒中复发风险显著增加(TI评分范围为-0.25至0);第1组(范围为-1到-0.5)调整后风险比(HR)为13.43 (95%CI为5.95-30.35);第2组(范围为-0.5到-0.25)调整后HR为4.59 (95%CI为2.01-10.46);第4组(TI评分为0分)调整后HR为6.60 (95%CI为3.02-14.45);但第5组则无关(范围为0-1),调整后HR为1.68 (95%CI为0.62-4.56)。当对有高血压、服用降压药史、无房颤、定期门诊就诊和出院时按功能进行分层的受试者进行分析时,最低TI评分组的风险升高仍然持续。

由此可见,低TI评分意味着医生在患者血压管理方面存在治疗惰性,与卒中复发的高风险相关。TI评分可能是门诊一个有用的指标,以防止卒中复发。

原始出处:

Beom Joon Kim.et al.Treatment Intensification for Elevated Blood Pressure and Risk of Recurrent Stroke.J AM HEART ASSOC.2021.https://www.ahajournals.org/doi/full/10.1161/JAHA.120.019457

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    2021-04-02 zhaohui6731
  5. [GetPortalCommentsPageByObjectIdResponse(id=1905573, encodeId=560119055e338, content=<a href='/topic/show?id=0eb34259ea1' target=_blank style='color:#2F92EE;'>#复发风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42597, encryptionId=0eb34259ea1, topicName=复发风险)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca20190, createdName=wushaoling, createdTime=Thu Apr 08 21:01:08 CST 2021, time=2021-04-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1718957, encodeId=a8b81e1895737, content=<a href='/topic/show?id=32b888935ca' target=_blank style='color:#2F92EE;'>#血压升高#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88935, encryptionId=32b888935ca, topicName=血压升高)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c86e32676392, createdName=zhang92571, createdTime=Mon Sep 20 17:01:08 CST 2021, time=2021-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1820447, encodeId=ac24182044ea8, content=<a href='/topic/show?id=c87f10089032' target=_blank style='color:#2F92EE;'>#风险的关系#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100890, encryptionId=c87f10089032, topicName=风险的关系)], attachment=null, authenticateStatus=null, createdAvatar=http://login.medsci.cn/upload/avatar/cc81592b507031e3cfd8d4c57911d98b/62c22832a9474aea1ca90ca058aebc03.jpg, createdBy=bed5446, createdName=limedical1974, createdTime=Sun Jul 04 08:01:08 CST 2021, time=2021-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1268478, encodeId=141412684e8ce, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Fri Apr 02 13:01:08 CST 2021, time=2021-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1391631, encodeId=d53d13916315a, content=<a href='/topic/show?id=f8ab3603664' target=_blank style='color:#2F92EE;'>#卒中复发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36036, encryptionId=f8ab3603664, topicName=卒中复发)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLc3PoqaNe4QTZ947pojXuchvvmkkJN0wyBBbA3LVX2WDkgiaJ7cswu9yvA4CB0NicjcrCfBY1zRPkA/132, createdBy=b3812500089, createdName=ms6897892027066920, createdTime=Fri Apr 02 13:01:08 CST 2021, time=2021-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=953126, encodeId=71f59531269a, content=点赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66942067627, createdName=1881ef655dm, createdTime=Thu Apr 01 17:35:01 CST 2021, time=2021-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026808, encodeId=349610268086d, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Thu Apr 01 01:01:08 CST 2021, time=2021-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=952936, encodeId=2cf795293674, content=血压对卒中影响, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5e445475594, createdName=ms4000001773094259, createdTime=Wed Mar 31 22:26:51 CST 2021, time=2021-03-31, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1905573, encodeId=560119055e338, content=<a href='/topic/show?id=0eb34259ea1' target=_blank style='color:#2F92EE;'>#复发风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42597, encryptionId=0eb34259ea1, topicName=复发风险)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca20190, createdName=wushaoling, createdTime=Thu Apr 08 21:01:08 CST 2021, time=2021-04-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1718957, encodeId=a8b81e1895737, content=<a href='/topic/show?id=32b888935ca' target=_blank style='color:#2F92EE;'>#血压升高#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88935, encryptionId=32b888935ca, topicName=血压升高)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c86e32676392, createdName=zhang92571, createdTime=Mon Sep 20 17:01:08 CST 2021, time=2021-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1820447, encodeId=ac24182044ea8, content=<a href='/topic/show?id=c87f10089032' target=_blank style='color:#2F92EE;'>#风险的关系#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100890, encryptionId=c87f10089032, topicName=风险的关系)], attachment=null, authenticateStatus=null, createdAvatar=http://login.medsci.cn/upload/avatar/cc81592b507031e3cfd8d4c57911d98b/62c22832a9474aea1ca90ca058aebc03.jpg, createdBy=bed5446, createdName=limedical1974, createdTime=Sun Jul 04 08:01:08 CST 2021, time=2021-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1268478, encodeId=141412684e8ce, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Fri Apr 02 13:01:08 CST 2021, time=2021-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1391631, encodeId=d53d13916315a, content=<a href='/topic/show?id=f8ab3603664' target=_blank style='color:#2F92EE;'>#卒中复发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36036, encryptionId=f8ab3603664, topicName=卒中复发)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLc3PoqaNe4QTZ947pojXuchvvmkkJN0wyBBbA3LVX2WDkgiaJ7cswu9yvA4CB0NicjcrCfBY1zRPkA/132, createdBy=b3812500089, createdName=ms6897892027066920, createdTime=Fri Apr 02 13:01:08 CST 2021, time=2021-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=953126, encodeId=71f59531269a, content=点赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66942067627, createdName=1881ef655dm, createdTime=Thu Apr 01 17:35:01 CST 2021, time=2021-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026808, encodeId=349610268086d, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Thu Apr 01 01:01:08 CST 2021, time=2021-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=952936, encodeId=2cf795293674, content=血压对卒中影响, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5e445475594, createdName=ms4000001773094259, createdTime=Wed Mar 31 22:26:51 CST 2021, time=2021-03-31, status=1, ipAttribution=)]
    2021-04-01 1881ef655dm

    点赞

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1905573, encodeId=560119055e338, content=<a href='/topic/show?id=0eb34259ea1' target=_blank style='color:#2F92EE;'>#复发风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42597, encryptionId=0eb34259ea1, topicName=复发风险)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca20190, createdName=wushaoling, createdTime=Thu Apr 08 21:01:08 CST 2021, time=2021-04-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1718957, encodeId=a8b81e1895737, content=<a href='/topic/show?id=32b888935ca' target=_blank style='color:#2F92EE;'>#血压升高#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88935, encryptionId=32b888935ca, topicName=血压升高)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c86e32676392, createdName=zhang92571, createdTime=Mon Sep 20 17:01:08 CST 2021, time=2021-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1820447, encodeId=ac24182044ea8, content=<a href='/topic/show?id=c87f10089032' target=_blank style='color:#2F92EE;'>#风险的关系#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100890, encryptionId=c87f10089032, topicName=风险的关系)], attachment=null, authenticateStatus=null, createdAvatar=http://login.medsci.cn/upload/avatar/cc81592b507031e3cfd8d4c57911d98b/62c22832a9474aea1ca90ca058aebc03.jpg, createdBy=bed5446, createdName=limedical1974, createdTime=Sun Jul 04 08:01:08 CST 2021, time=2021-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1268478, encodeId=141412684e8ce, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Fri Apr 02 13:01:08 CST 2021, time=2021-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1391631, encodeId=d53d13916315a, content=<a href='/topic/show?id=f8ab3603664' target=_blank style='color:#2F92EE;'>#卒中复发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36036, encryptionId=f8ab3603664, topicName=卒中复发)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLc3PoqaNe4QTZ947pojXuchvvmkkJN0wyBBbA3LVX2WDkgiaJ7cswu9yvA4CB0NicjcrCfBY1zRPkA/132, createdBy=b3812500089, createdName=ms6897892027066920, createdTime=Fri Apr 02 13:01:08 CST 2021, time=2021-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=953126, encodeId=71f59531269a, content=点赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66942067627, createdName=1881ef655dm, createdTime=Thu Apr 01 17:35:01 CST 2021, time=2021-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026808, encodeId=349610268086d, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Thu Apr 01 01:01:08 CST 2021, time=2021-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=952936, encodeId=2cf795293674, content=血压对卒中影响, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5e445475594, createdName=ms4000001773094259, createdTime=Wed Mar 31 22:26:51 CST 2021, time=2021-03-31, status=1, ipAttribution=)]
    2021-04-01 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1905573, encodeId=560119055e338, content=<a href='/topic/show?id=0eb34259ea1' target=_blank style='color:#2F92EE;'>#复发风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42597, encryptionId=0eb34259ea1, topicName=复发风险)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca20190, createdName=wushaoling, createdTime=Thu Apr 08 21:01:08 CST 2021, time=2021-04-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1718957, encodeId=a8b81e1895737, content=<a href='/topic/show?id=32b888935ca' target=_blank style='color:#2F92EE;'>#血压升高#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88935, encryptionId=32b888935ca, topicName=血压升高)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c86e32676392, createdName=zhang92571, createdTime=Mon Sep 20 17:01:08 CST 2021, time=2021-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1820447, encodeId=ac24182044ea8, content=<a href='/topic/show?id=c87f10089032' target=_blank style='color:#2F92EE;'>#风险的关系#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100890, encryptionId=c87f10089032, topicName=风险的关系)], attachment=null, authenticateStatus=null, createdAvatar=http://login.medsci.cn/upload/avatar/cc81592b507031e3cfd8d4c57911d98b/62c22832a9474aea1ca90ca058aebc03.jpg, createdBy=bed5446, createdName=limedical1974, createdTime=Sun Jul 04 08:01:08 CST 2021, time=2021-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1268478, encodeId=141412684e8ce, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Fri Apr 02 13:01:08 CST 2021, time=2021-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1391631, encodeId=d53d13916315a, content=<a href='/topic/show?id=f8ab3603664' target=_blank style='color:#2F92EE;'>#卒中复发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36036, encryptionId=f8ab3603664, topicName=卒中复发)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLc3PoqaNe4QTZ947pojXuchvvmkkJN0wyBBbA3LVX2WDkgiaJ7cswu9yvA4CB0NicjcrCfBY1zRPkA/132, createdBy=b3812500089, createdName=ms6897892027066920, createdTime=Fri Apr 02 13:01:08 CST 2021, time=2021-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=953126, encodeId=71f59531269a, content=点赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66942067627, createdName=1881ef655dm, createdTime=Thu Apr 01 17:35:01 CST 2021, time=2021-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026808, encodeId=349610268086d, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Thu Apr 01 01:01:08 CST 2021, time=2021-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=952936, encodeId=2cf795293674, content=血压对卒中影响, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5e445475594, createdName=ms4000001773094259, createdTime=Wed Mar 31 22:26:51 CST 2021, time=2021-03-31, status=1, ipAttribution=)]
    2021-03-31 ms4000001773094259

    血压对卒中影响

    0

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