积极的医疗管理可能有助于减少卒中危险因素的差异
By American Heart Association News
患过中风的黑人比非黑人有更多的心血管风险因素, but those risks may be reduced through intensive interventions, new research suggests.
The study, published Thursday in the American Heart Association journal Stroke, 发现由于大脑大动脉严重堵塞而中风的黑人成年人更年轻, 与非黑人同龄人相比，他们更容易患高血压和2型糖尿病，更不可能进行体育锻炼. But one year of aggressive, 个性化医疗管理改善了他们的血压水平和身体活动得分, reducing those disparities.
"Modifiable stroke risk factor differences between Black and non-Black adults were found at enrollment; however, 我们的研究表明，这些问题可以通过量身定制的护理来解决，包括生活方式指导, medication alterations or additions if appropriate, access to routine health care support and regular physician follow-up," Dr. Ashley Nelson, a co-author of the study, said in a news release. At the time of the study, 纳尔逊是查尔斯顿南卡罗来纳医科大学的神经内科住院医生.
“严格的风险因素管理在改善或消除黑人成年人的这些风险因素差异方面发挥着重要作用," Nelson said.
Using health data from SAMMPRIS, 颅内狭窄患者支架置入术及积极治疗预防卒中复发的研究, researchers analyzed medication use and vascular risk factors, including systolic and diastolic blood pressure, levels of low-density lipoprotein ("bad" cholesterol) and blood glucose, 以及最近中风的黑人和非黑人的身体活动得分. 身体活动水平是通过一份自我评估的问卷来衡量的，该问卷考察了参与者每周进行适度和剧烈运动的频率.
研究人员在研究开始时和一年后分析了104名黑人成年人和347名非黑人成年人的数据. The non-Black participants included white, 亚裔和西班牙裔成年人被集中研究，因为没有一个群体大到足以单独分析.
At the time of enrollment, Black study participants were an average 57 years old, compared to 61 for non-Black participants. About 95% of Black participants had high blood pressure, compared to 87.5% of non-Black participants. More Black participants (52.9%) had Type 2 diabetes than non-Black participants (39.7%). 黑人成年人的平均舒张压读数也更高，为82.4 mmHg versus 79.5 mmHg, and lower physical activity scores.
Following enrollment, participants took part in a one-year aggressive, 医疗管理干预包括加强血压的医学控制, cholesterol, diabetes, 吸烟和体育活动水平，以及生活方式指导和定期随访卫生保健专业人员.
After one year of the intervention program, 舒张压(测量中的“底”值)的差异缩小了. The average diastolic measurement for Black participants dropped to 74.7 mmHg, compared to 75.5 mmHg for all other participants. 舒张压反映了两次心跳之间血管的压力. A normal reading is below 80 mmHg.
"We tend to focus on systolic blood pressure, 然而，舒张压也是心血管健康和血管完整性的良好标志," Nelson said. “使用量身定制的方法可以更好地控制参与者的风险因素."
作者将舒张压的下降归因于黑人参与者在干预期间服用降压药的比例增加了一倍.
在干预年度结束时，身体活动方面的差距也有所缩小, 黑人参与者的平均得分显著提高. It also was slightly higher than for all other participants.
作者指出，他们的发现提出了其他因素可能在差异中发挥作用的问题.
“需要许多不同的方法来减少和消除黑人成年人的这些差异," Nelson said. "Access to health care, lifestyle coaching, 中风后的早期随访和适当的药物治疗可能有助于解决这个问题, but not wholly in terms of overall risk and all baseline disparities."