| Background:Ischemic cerebrovascular disease includes transient ischemic attack,ischemic stroke,and so on.Stroke is a leading cause of mortality and disability wordwide,it has become the most common cause of death according to the results of the third national survey.,ischemic stroke accounts for 70%-80%of the total stroke population.Hypertension is generally considered to be one of the strongest modifiable risk factors of stroke and atherosclerosis.Meanwhile,atherosclerosis is the primary etiology of ischemic stroke and transient ischemic attack(TIA).Blood pressure is a simple and common physiologic parameter,can be modulated by patient's mental state,endocrine environment,the external environment,and other factors.Therefore,the blood pressure readings obtained by different measurement equipment and environment,which also have different value for the diagnosis of hypertension.Clinical blood pressure is still the gold standard for diagnosis of hypertension and efficacy evaluation for now,but the value of ambulatory blood pressure measurement(ABPM)and home blood pressure measurement(HBPM)for the diagnosis and evaluation of hypertension were recommended by many hypertension guidelines.In addition,by more and more profound studies,we found that different blood pressure parameters,such as mean blood pressure,blood pressure variability(BPV),and so on,have different predictive value for prognosis among ischemic stroke and TIA patients.Objectives:In this study,we aimed to describe the rationale,study design,and the baseline characteristics of a nationwide BP database,and explore the predictive value of different blood pressure parameters,based on different measurement method,for the prognosis of patients with ischemic stroke or TIA.Methods:1.Conducted the cohort study of blood pressure and clincal outcomes in ischemic stroke or TIA in China(BOSS):the BOSSstudy was led by Beijing Taintan Hospital,Capital Medical University,and started at 61 centers throughout the country in sep.2012.The BOSSstudy was a prospective,multicenter,and observational cohort study.Patients were recruited consecutively if the following conditions were met:age of 18years or older,diagnosis of acute ischemic stroke or TIA,within 7days of the index events and sign informed conset.Clinical outcomes included stroke recurrence(ischemic stroke or hemorrhagic stroke),combined vascular events(stroke/TIA recurrence,myocardial infarction,heart failure,and vascular operation),and death.We collected clinical blood pressure at different time,ABPM and self-measured blood pressure during hospitalization,HBPM from discharge,baseline information,outcomes and so on during the study.Follow-up times were baseline,3-month,6-month,and 1-year.2.The relationship between systolic blood pressure level and stroke recurrence:enrolled the participants who had 7days or more of self-measured blood pressure readings within 90days after index event onset from the BOSS database.The mean value of self-maesured blood pressure within 90days after ictus but before recurrent stroke was used for data analysis.The SBP value were categorized by 10mmHg increments:<115,115 to 124,125 to 134,135 to 144,145 to 154,155 to 164,and>165 mmHg.The clinical outcome was stroke recurrence within lyear.Cox proportional hazards models were used to estimate the effects of SBP on recurrent stroke.Restricted cubic spline was used to explore the shape of the association between SBP and stroke recurrence.3.The predictive value of short-term and long-term BPV for stroke recurrence:included the patients who had ABPM reading?56times and HBPM ?7ays in the BOSS study.Variability for systolic blood pressure(SBP)was assessed as the standard deviation(SD),coefficients of variance(CV).The primary outcome was recurrent stroke within lyear.Cox proportional hazards models were used to test the association of short-term BPV,long-term BPV,and stroke recurrence.Results:1.BOSS database establishment:a total of 2608 ischemic stroke or TIA were consecutively enrolled from Oct.2012 to Feb.2016 at 61 centers in china.Mean age 62.50±11.10years,female 845(32.4%),ischemic stroke patients 2318(88.9%),TIA patients290(11.1%),all the patients compeleted cinical blood pressure,2414 participants(93.0%)fullfiled ABPM during hospitalization,2470patients(94.7%)compeleted HBPM at 3-month follow up,2425 patients accomplished HBPM at 1year follow-up.82patients(3.1%)lost follow-up at 3-month and 132 participants(5.1%)lost at lyear follow up.The events rate of stroke recurrence,death,and combined vascular event were 125(4.8%),21(0.8%),and 146(5.6%)at 3-month follow up,during one year follow up,the events rates of recurrence stroke,death,and combined vascular event were 159(6.1%),51(2.0%),and 207(7.9%).2.The relationship between different systolic blood pressure level and stroke recurrence within 1 year:enrolled 2397patients from BOSS study,aged?65years 946 patients(39.5%),female 32.4%.115participants(4.8%)accurred recurrent stroke during one year follow-up.A J-shaped association of SBP with stroke recurrence was observed(P nonlinearity<0.001).Compared with 115-124mmHg group,the adjusted hazard ratio(HR)and 95%confidence interval(CI)of<115mmHg.125-134mmHg?135-144mmHg?145-154mmHg?155-164mmHg?and?165mmHg were 1.92(0.57-6.46),0.97(0.44-2.18),1.15(0.52-2.55),1.11(0.47-2.63),3.35(1.28-8.73),and 6.35(2.23-18.09).3.The Comparison of long-term BPV and short-term BPV on predictive value for stroke recurrence within 1 year:included 1764 participants of BOSS study,mean age 62.45±10.99 years,32.1%were female.106patients accurred stroke recurrence within one year follow-up.Increased long-term BPV were significantly associated with stroke recurrence(SD:adjusted HR 1.94,95%CI 1.12-3.35;CV:adjusted HR 1.96,95%CI 1.17-3.26),independent of mean SBP.However,increased short-term BPV(SD,CV)was not associated with stroke recurrence(SD:adjusted HR1.25,95%CI 0.68-2.28;CV:adjusted HR 1.14,95%CI 0.64-2.04).Conclusions:Established a nationwide,hospital-based,prospective,multicenter database of ischemic cerebralvascular disease with different blood pressure parameter.Among ischemic stroke or TIA patients,there is a J-shaped curve between the systolic blood pressure level after onset and stroke recurrence;The long-term BPV of systolic blood pressure is a better predictor than short-term BPV for recurrent in patients with ischemic stroke or TIA. |
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