Abstract：
There is scarce evidence of the role of clinic and ambulatory BP indices, as well as blood pressure phenotypes in the prognosis of stroke survivors. We aimed to evaluate the association between ambulatory BP indices and mortality in patients with a previous stroke. Our study was an observational cohort study from individuals included in the Spanish Ambulatory Blood Pressure Registry from March 2004 to December 2014. The Cox model was used to estimate associations between usual clinic and ambulatory BP and mortality, adjusted for confounders and additionally for alternative measures of BP. Two thousand one hundred and eighty-three patients with a previous stroke were included. During a median of 9.2 years, 632 (28.9%) patients died: 236 (10.8%) from cardiovascular causes. In the confounder-adjusted model, clinic systolic BP was not associated with the risk of all-cause or cardiovascular mortality. In contrast, systolic BP indices obtained through ABPM (24 h, day and night) were all associated with all-cause and cardiovascular death. In the simultaneous adjustment of daytime and night-time systolic BP, only night-time systolic BP remained significantly associated with all-cause and cardiovascular death: HR 1.35 (95% CI 01.21-1.51) and 1.44 (1.20-1.72), respectively. For diastolic BP, only night-time BP was associated with all-cause and cardiovascular mortality: HR 1.32 (1.18-1.48) and 1.57 (1.31-1.88), respectively. According to the circadian pattern, a riser pattern was associated with all-cause and cardiovascular mortality: HR 1.49 (1.18-1.87) and 1.70 (1.14-2.52), respectively. In conclusion, in patients who have suffered a stroke, night-time BP is the BP estimate most closely associated with all-cause and cardiovascular mortality.
摘要：
很少有证据表明临床和动态血压指数的作用，以及血压表型对卒中幸存者预后的影响。我们旨在评估既往卒中患者的动态血压指数与死亡率之间的关系。我们的研究是一项观察性队列研究，来自2004年3月至2014年12月西班牙动态血压注册中的个体。Cox模型用于估计常规临床和动态血压与死亡率之间的关联。针对混杂因素进行了调整，并额外针对BP的替代措施进行了调整。包括两千一百八十三名先前中风的患者。在9.2年的中位数中，632例（28.9%）患者死亡：236例（10.8%）因心血管原因死亡。在混淆调整模型中，临床收缩压与全因死亡或心血管死亡风险无关.相比之下,通过ABPM获得的收缩压BP指数(24h，白天和黑夜）都与全因死亡和心血管死亡有关。在同时调整白天和夜间收缩压时，仅夜间收缩压与全因死亡和心血管死亡显著相关:HR1.35(95%CI01.21-1.51)和1.44(1.20-1.72),分别。舒张压血压，仅夜间血压与全因死亡率和心血管死亡率相关：HR1.32（1.18-1.48）和1.57（1.31-1.88），分别。根据昼夜节律,上升模式与全因死亡率和心血管死亡率相关：HR1.49（1.18-1.87）和1.70（1.14-2.52），分别。总之,在中风患者中，夜间血压是与全因死亡率和心血管死亡率最密切相关的血压估计值.
