基于ABC路径的血压控制水平对老年非瓣膜性房颤合并高血压患者卒中风险的影响

doi:10.3969/j.issn.1003-9198.2026.05.013

摘要/Abstract

摘要： 目的基于心房颤动(房颤)综合管理ABC路径,探讨血压控制对老年非瓣膜性房颤(NVAF)合并高血压患者缺血性卒中风险的影响,分析血压控制在ABC路径降低卒中风险中的中介作用。方法采用病例对照研究设计,纳入2019年8月至2023年11月江苏省省级机关医院住院治疗的≥65岁NVAF合并高血压患者。将发生缺血性卒中的182例患者作为病例组,并按1∶2比例匹配364例未发生卒中者作为对照组。通过多因素条件logistic回归分析卒中风险相关因素,采用Bootstrap法检验血压控制的中介效应。结果病例组血压控制不良(SBP≥140 mmHg)的比例显著高于对照组(65.40%比41.48%, P<0.001),而完全遵循ABC路径的比例则显著低于对照组(8.80%比28.60%, P<0.001)。多因素分析显示,与未遵循任何ABC路径相比,完全遵循ABC路径可使卒中风险降低89%(OR=0.11, 95%CI: 0.04～0.31);血压控制不良(OR=2.38, 95%CI: 1.57～3.61)是卒中风险的独立危险因素。中介效应分析表明,ABC路径对卒中风险的总效应中,有26.10%是通过降低SBP实现的(间接效应值=-0.165, Bootstrap 95%CI:-0.286～-0.054)。结论在老年NVAF合并高血压患者中,遵循ABC路径并严格控制血压(<140 mmHg)是降低缺血性卒中风险的关键。血压控制既是独立保护因素,也是ABC路径发挥心血管保护作用的重要中介环节。

关键词: 非瓣膜性房颤, 缺血性卒中, ABC路径, 高血压, 病例对照研究

Abstract: Objective Based on the Atrial fibrillation Better Care (ABC) pathway, this study aimed to investigate the impact of blood pressure control on ischemic stroke in elderly patients with non-valvular atrial fibrillation (NVAF) and hypertension, and to analyze the mediating role of blood pressure control in the stroke risk reduction associated with the ABC pathway. Methods A case-control study was conducted including patients aged ≥65 years with NVAF and hypertension hospitalized at Jiangsu Province Offical Hospital between August 2019 and November 2023. The case group comprised 182 patients with ischemic stroke, and the control group consisted of 364 stroke-free patients matched at a 1∶2 ratio. Multivariate logistic regression was used to identify factors associated with stroke risk, and the Bootstrap method was applied to examine the mediating effect of blood pressure control. Results The proportion of patients with uncontrolled blood pressure [systolic blood pressure (SBP) ≥140 mmHg] was significantly higher in the case group than that in the control group (65.40% vs 41.48%, P<0.01), while the rate of full adherence to the ABC pathway was significantly lower in the case group (8.80% vs 28.60%, P<0.001). Multivariate logistic analysis showed that, compared with no adherence to any component of the ABC pathway, full adherence was associated with an 89% reduction in stroke risk (OR=0.11, 95%CI: 0.04-0.31). Uncontrolled blood pressure (OR=2.38, 95%CI: 1.57-3.61) was independent risk factor for stroke. Mediation analysis indicated that 26.10% of the total effect of the ABC pathway on stroke risk was mediated through the reduction of SBP (indirect effect estimate=-0.165, Bootstrap 95%CI: -0.286 to -0.054). Conclusions In elderly patients with NVAF and hypertension, adherence to the ABC pathway and strict blood pressure control (<140 mmHg) are crucial for reducing the risk of ischemic stroke. Blood pressure control serves not only as an independent protective factor but also as a key mediating mechanism through which the ABC pathway exerts cardiovascular protective effects.

Key words: non-valvular atrial fibrillation, ischemic stroke, ABC pathway, hypertension, case-control study

中图分类号:

贾世芬, 熊亚晴, 周黎黎, 徐斐, 窦毓. 基于ABC路径的血压控制水平对老年非瓣膜性房颤合并高血压患者卒中风险的影响[J]. 实用老年医学, 2026, 40(5): 500-504.

JIA Shifen, XIONG Yaqing, ZHOU Lili, XU Fei, DOU Yu. Impact of blood pressure control through the ABC pathway on stroke risk in elderly patients with non-valvular atrial fibrillation and hypertension[J]. Practical Geriatrics, 2026, 40(5): 500-504.

参考文献

[1] HU S S. Report on cardiovascular health and diseases in China 2021: an updated summary[J]. J Geriatr Cardiol, 2023, 20(6): 399-430.
[2] WANG Z, CHEN Z, WANG X, et al. The disease burden of atrial fibrillation in China from a national cross-sectional survey[J]. Am J Cardiol, 2018, 122(5): 793-798.
[3] PROIETTI M, LIP G Y H, LAROCHE C, et al. Relation of outcomes to ABC (Atrial Fibrillation Better Care) pathway adherent care in European patients with atrial fibrillation: an analysis from the ESC-EHRA EORP Atrial Fibrillation General Long-Term (AFGen LT) Registry[J]. Europace, 2021, 23(2): 174-183.
[4] HINDRICKS G, POTPARA T, DAGRES N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC[J]. Eur Heart J, 2021, 42(5): 373-498.
[5] STEVENS D, HARRISON S L, KOLAMUNNAGE-DONA R, et al. The Atrial Fibrillation Better Care pathway for managing atrial fibrillation: a review[J]. Europace, 2021, 23(10): 1511-1527.
[6] RIVERA-CARAVACA J M, ROLDÁN V, MARTÍNEZ-MONTESINOS L, et al. The atrial fibrillation better care (ABC) pathway and clinical outcomes in patients with atrial fibrillation: the prospective Murcia AF project phase II cohort[J]. J Gen Intern Med, 2023, 38(2): 315-323.
[7] ZHANG X, HUANG J, WENG F, et al. Adherence to atrial fibrillation better care (ABC) pathway management of Chinese community elderly patients with atrial fibrillation: a cross-sectional study[J]. Patient Prefer Adherence, 2023, 17: 1813-1823.
[8] 国家心血管病中心国家基本公共卫生服务项目基层高血压管理办公室, 国家基层高血压管理专家委员会. 国家基层高血压防治管理指南2020版[J]. 中国循环杂志, 2021, 36(3): 209-220.
[9] GUO Y, IMBERTI J F, KOTALCZYK A, et al. Atrial fibrillation better care pathway adherent care improves outcomes in Chinese patients with atrial fibrillation[J]. JACC Asia, 2022, 2(4): 422-429.
[10] 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9): 666-682.
[11] SAGRIS D, LIP G Υ Η, KOROMPOKI E, et al. Adherence to an integrated care pathway for stroke is associated with lower risk of major cardiovascular events: a report from the Athens Stroke Registry[J]. Eur J Intern Med, 2024, 122: 61-67.
[12] WATSON T, SHANTSILA E, LIP G Y H. Mechanisms of thrombogenesis in atrial fibrillation: Virchow’s triad revisited[J]. Lancet, 2009, 373(9658): 155-166.
[13] GU H Q, YANG X, WANG C J, et al. Assessment of trends in guideline-based oral anticoagulant prescription for patients with ischemic stroke and atrial fibrillation in China[J]. JAMA Netw Open, 2021, 4(7): e2118816.
[14] LACKLAND D T, WEBER M A. Global burden of cardiovascular disease and stroke: hypertension at the core[J]. Can J Cardiol, 2015, 31(5): 569-571.
[15] GAWAŁKO M, LINZ D. Atrial fibrillation detection and management in hypertension[J]. Hypertension, 2023, 80(3): 523-533.
[16] AUNE D, MAHAMAT-SALEH Y, KOBEISSI E, et al. Blood pressure, hypertension and the risk of atrial fibrillation: a systematic review and meta-analysis of cohort studies[J]. Eur J Epidemiol, 2023, 38(2): 145-178.
[17] ELSHEIKH S, HILL A, IRVING G, et al. Atrial fibrillation and stroke: state-of-the-art and future directions[J]. Curr Probl Cardiol, 2024, 49(1 Pt C): 102181.