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目的探讨症状性脑动脉狭窄未行支架植入患者个体化血压调治技术的效果、终点事件及安全性。方法初发的症状性脑动脉狭窄患者1126例,随机分为治疗组787例,对照组339例。治疗组给予个体化血压调治技术,以8个层次最佳目标血压根据病情给予实施;对照组参照中国高血压防治指南对血压进行调控。比较2组治疗后3年和5年健康功能水平、终点事件、不良反应、依从性情况。结果治疗组治疗3年和5年后健康功能水平均高于对照组(P<0.05);治疗组3年和5年脑梗死发生和复发、心脏事件发生率均明显低于对照组(6.0%vs 13.3%、9.5%vs 19.2%、5.9%vs 12.4%,P<0.01)。治疗后5年病死率低于对照组(4.2%vs 7.4%,P<0.05)。2组出血性表现、心肾功能不全和高血压脑病发生率差异无统计学意义(P>0.05)。治疗组退出率低于对照组(5.3%vs13.6%,P<0.05)。结论症状性脑动脉狭窄未行支架植入患者个体化血压调治技术可显著降低脑梗死发生和复发、心脏事件和病死率,极大提高功能健康水平,效果显著,使用安全,患者依从性好。
Objective To investigate the effect, end point and safety of individualized blood pressure control in patients with symptomatic cerebral arterial stenosis who underwent stent implantation. Methods A total of 1126 patients with symptomatic cerebral artery stenosis were randomly divided into treatment group (787 cases) and control group (339 cases). The treatment group was given individualized blood pressure regulation technique, and the optimal target blood pressure was administered according to the condition at eight levels. The control group was controlled according to the guidelines of Chinese hypertension prevention and control. The levels of health function, end-point events, adverse reactions and compliance were compared between the two groups after 3 and 5 years of treatment. Results After 3 years and 5 years of treatment, the level of health function in the treatment group was higher than that in the control group (P <0.05). The occurrence and recurrence of cerebral infarction and the incidence of cardiac events in the treatment group at 3 and 5 years were significantly lower than those in the control group (6.0% vs 13.3%, 9.5% vs 19.2%, 5.9% vs 12.4%, P <0.01). The 5-year mortality after treatment was lower than that of the control group (4.2% vs 7.4%, P <0.05). There were no significant differences in the hemorrhagic manifestations, the incidence of heart-kidney dysfunction and hypertensive encephalopathy between the two groups (P> 0.05). The withdrawal rate of the treatment group was lower than that of the control group (5.3% vs13.6%, P <0.05). Conclusion Individualized blood pressure control in patients with symptomatic cerebral arterial stenosis without stent implantation can significantly reduce the occurrence and recurrence of cerebral infarction, cardiac events and mortality, greatly improve functional and health level, with significant effect, safe use and good patient compliance.