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

Abstract

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

CLC Number:

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.

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Impact of blood pressure control through the ABC pathway on stroke risk in elderly patients with non-valvular atrial fibrillation and hypertension

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