既往研究显示，在强化降低收缩压的情况下，血压和心血管事件呈J型曲线相关性，血压和卒中是否也存在这种相似相关性尚未知。因此，美国学者们开展了一项随机研究，旨在近期发生腔隙性脑梗死患者中对比收缩压控制在稍高水平(130–149 mm Hg)与稍低水平(<130 mm Hg)的差异。在随机化6个月后，评估血压平均达标情况与卒中复发、严重血管事件和全因死亡的相关性。

结果显示，在平均随访3.7年后，血压达标与患者转归之间存在J型相关性，最低风险的血压水平：收缩压约为124 mm Hg和舒张压为 67 mm Hg。收缩压高于124 mm Hg时，每升高1标准差(11.1 mm Hg)与死亡增加有关(校正危险比：1.9)，而低于这个水平时，这种相关性则相反。舒张压高于67 mm Hg时，每升高1标准差(8.2 mm Hg)与卒中风险增加有关，而低于此水平时，这种相关性也相反。

该研究表明，保持腔隙性脑梗死患者所有事件风险最低的血压水平为(收缩压≈120 - 128 mm Hg，舒张压65-70 mm Hg)。未来还需进一步评估积极降压的影响，尤其是在既往存在血管疾病的老年人群中。

研究论文近期在线发表于《高血压》(Hypertension)杂志。

参考文献：Michelle C. Odden,et al.HYPERTENSIONAHA.115.06480Published online before print November 9, 2015,doi: 10.1161/HYPERTENSIONAHA.115.06480

原文

Achieved Blood Pressure and Outcomes in the Secondary Prevention of Small Subcortical Strokes Trial
1. Michelle C. Odden,
2. Leslie A. McClure,
3. B. Peter Sawaya,
4. Carole L. White,
5. Carmen A. Peralta,
6. Thalia S. Field,
7. Robert G. Hart,
8. Oscar R. Benavente,
9. Pablo E. Pergola
-Author Affiliations
1. From the School of Biological and Population Health Sciences, Oregon State University, Corvallis (M.C.O.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Division of Nephrology, Department of Internal Medicine, Bone and Mineral Metabolism, University of Kentucky, Lexington (B.P.S.); Department of Health Restoration and Care Systems Management, School of Nursing, University of Texas Health Science Center, San Antonio (C.L.W.); Department of Medicine, University of California, San Francisco (C.A.P.); Center for Brain Health, Department of Medicine, University of British Columbia, Vancouver, Canada (T.S.F., O.R.B.); Population Health Research Institute, Hamilton, CA (R.G.H.); and Renal Associates PA, San Antonio, TX (P.E.P.).

Abstract
Studies suggest a J-shaped association between blood pressure and cardiovascular events in the setting of intensive systolic blood pressure control; whether there is a similar association with stroke remains less well established. The Secondary Prevention of Small Subcortical Strokes was a randomized trial to evaluate higher (130–149 mm Hg) versus lower (<130 mm Hg) systolic blood pressure targets in participants with recent lacunar infarcts. We evaluated the association of mean achieved blood pressure, 6 months after randomization, and recurrent stroke, major vascular events, and all-cause mortality. After a mean follow up of 3.7 years, there was a J-shaped association between achieved blood pressure and outcomes; the lowest risk was at ≈124 and 67 mm Hg systolic and diastolic blood pressure, respectively. For example, above a systolic blood pressure of 124 mm Hg, 1 standard deviation higher (11.1 mm Hg) was associated with increased mortality (adjusted hazard ratio: 1.9; 95% confidence interval: 1.4, 2.7), whereas below this level, this relationship was inverted (0.29; 0.10, 0.79), P<0.001 for interaction. Above a diastolic blood pressure of 67 mm Hg, a 1 standard deviation higher (8.2 mm Hg) was associated with an increased risk of stroke (2.2; 1.4, 3.6), whereas below this level, the association was in the opposite direction (0.34; 0.13, 0.89), P=0.02 for interaction.The lowest risk of all events occurred at a nadir of ≈120 to 128 mm Hg systolic blood pressure and 65 to 70 mm Hg diastolic blood pressure. Future studies should evaluate the impact of excessive blood pressure reduction, especially in older populations with preexisting vascular disease.
HYPERTENSIONAHA.115.06480Published online before print November 9, 2015,doi: 10.1161/HYPERTENSIONAHA.115.06480