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White Matter Hyperintensity, Immediate Antihypertensive Treatment, and Functional Outcome After Acute Ischemic Stroke.

急性缺血性卒中后白质高信号、即刻降压治疗和功能结局。

  • 影响因子:4.94
  • DOI:10.1161/STROKEAHA.119.028841
  • 作者列表:"Zhu S","Qian S","Xu T","Peng H","Dong R","Wang D","Yuan X","Guo L","Zhang Y","Geng D","Zhong C
  • 发表时间:2020-04-01
Abstract

:Background and Purpose- It remains unknown that whether white matter hyperintensity (WMH) severity influences the effect of antihypertensive treatment in acute ischemic stroke. We aimed to investigate the effects of early antihypertensive treatment on death and disability among patients with acute ischemic stroke according to WMH severities. Methods- This study was a secondary analysis of the data from CATIS (China Antihypertensive Trial in Acute Ischemic Stroke). Severity of WMH was evaluated using Fazekas rating scale score among 303 participants with available magnetic resonance imaging data and was categorized into none-mild WMH (Fazekas score 0-2) and moderate-severe WMH (Fazekas score 3-6). Functional outcome was death or major disability (modified Rankin Scale score of ≥3) at 14 days or hospital discharge and within 3 months. Results- WMH severity was significantly associated with an increased risk of death or major disability. Each 1 score increase in Fazekas score was associated with an adjusted odds ratio (95% CI) of 1.25 (1.03-1.51) for 14 days or hospital discharge and 1.39 (1.12-1.72) for 3-month functional outcome. There were no significant interactions between antihypertensive treatment and WMH severity (both P>0.1) on functional outcome at 14 days or hospital discharge and within 3 months. The neutral effects of immediate antihypertensive treatment were observed both in patients with moderate-severe WMH and none-mild WMH. Conclusions- Participants with higher WMH burden had increased risk of death or major disability after acute ischemic stroke. Early antihypertensive treatment had a neutral effect on clinical outcomes among acute ischemic stroke patients with a variety of WMH severities. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT01840072.

摘要

: 背景和目的-脑白质高信号 (WMH) 的严重程度是否影响急性缺血性卒中降压治疗的效果仍不清楚。我们旨在根据 WMH 严重程度研究早期降压治疗对急性缺血性卒中患者死亡和残疾的影响。方法: 本研究是对 CATIS (中国急性缺血性卒中降压试验) 数据的二次分析。在 303 例有可用磁共振成像数据的参与者中,使用 Fazekas 评定量表评分评估 WMH 的严重程度,并将其分为无轻度 WMH (Fazekas 评分 0-2) 和中-重度 WMH (Fazekas 评分 3-6)。功能结局为 14 天或出院时和 3 个月内的死亡或重大残疾 (改良 Rankin 量表评分 ≥ 3 分)。结果-WMH 严重程度与死亡或重大残疾风险增加显著相关。Fazekas 评分每增加 1 分与 14 天 95% (1.25-1.03) 或出院和 1.51 (1.39-1.12) 的校正比值比 (1.72 CI) 相关 3 个月的功能结果。在 14 天或出院时和 3 个月内,降压治疗和 WMH 严重程度 (均 P>0.1) 对功能结局无显著相互作用。在中度-重度 WMH 和非轻度 WMH 患者中观察到即时降压治疗的中性效应。结论-具有较高 WMH 负荷的参与者在急性缺血性卒中后死亡或重大残疾的风险增加。在各种 WMH 严重程度的急性缺血性卒中患者中,早期降压治疗对临床结局具有中性影响。注册-URL: https://www.clinicaltrials.gov ; 唯一标识符: nct01840072。

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METHODS:BACKGROUND:'Neuronal precursor cell expressed developmentally down-regulated 4-like' (NEDD4L) is considered a candidate gene for hypertension-both functionally and genetically-through the regulation of the ubiquitination of the epithelial sodium channel (ENaC). This study explores the relationship between genetic variation in NEDD4L and hypertension with chronic kidney disease (CKD) in the southeastern Han Chinese population. METHODS:We recruited 623 CKD patients and measured ambulatory blood pressure monitoring (ABPM), and the rs4149601 and rs2288774 polymorphisms in NEDD4L were genotyped using qPCR. RESULTS:For rs4149601, significant differences in genotype frequencies in an additive model (GG vs GA vs AA) were observed between normotensive patients and hypertensive patients when hypertension was classified into ambulatory hypertension, clinical hypertension and ambulatory systolic hypertension (P = 0.038, 0.005 and 0.006, respectively). In a recessive model (GG+GA vs AA), the frequency of the AA genotype of rs4149601 in the hypertension groups were all higher than that in the normotensive groups. The genotype distribution of rs2288774 did not differ significantly between the normotensive and hypertensive patients. In both the full cohort and the propensity score matching (PSM) cohort, the AA genotype of rs4149601 (compared to the GG+GA genotype group) was independently correlated with ambulatory hypertension, clinical hypertension and ambulatory systolic hypertension by multivariate logistic regression analysis. CONCLUSIONS:The present study indicates that the AA genotype of rs4149601 associates with hypertension in CKD. Consequently, the rs4149601 A allele might be a risk factor for hypertension with CKD.

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