静息心率对高血压及非高血压人群脑卒中发病影响的前瞻性队列研究

目的 探讨贵州省人群静息心率对高血压及非高血压人群脑卒中发病的影响，为脑卒中的防控提供科学依据。方法 采取了多阶段整群随机抽样在贵州省抽取12个市（县、区）9 280名18岁及以上居民开展基线调查，并于2016—2020年开展随访，选取无脑卒中诊断的7 963人作为研究对象，使用竞争风险模型计算风险比（SHR）及95%CI值。结果 研究共纳入7 963人分析，中位随访6.50年后，共有202人发生或死于脑卒中疾病，发病密度为3.62/1 000人年。竞争风险模型调整相关因素分析结果显示:未发现在非高血压人群中静息心率（RHR）与各类脑卒中发病之间的相关性；在高血压人群中，当RHR≥76次/min时，脑卒中和缺血性脑卒中发病风险是RHR＜76次/min人群的1.896（SHR = 1.896，95%CI:1.170～3.072）和2.585（SHR = 2.585，95%CI:1.400～4.764）倍，但不会增加出血性脑卒中发病的风险（SHR = 0.919，95%CI:0.428～1.974）。结论 RHR与非高血压人群卒中的发生无相关性，控制RHR至76次/min以下将有效降低高血压人群脑卒中、缺血性脑卒中发病的风险。

The relationship between resting heart rate on the incidence of stroke in hypertensive and non-hypertensive population: a prospective cohort study

Objective To investigate the influence of resting heart rate on the incidence of stroke in hypertensive and non-hypertensive population of Guizhou Province, and to provide a scientific basis for the prevention and control of stroke. Methods A multi-stage cluster random sampling was adopted to select 9 280 residents aged 18 and over from 12 cities (counties and districts) in Guizhou Province to conduct a baseline survey. Follow-up was carried out from 2016 to 2020, and 7 963 people without stroke were selected. The competing risk model was used to calculate the risk ratio(SHR) and 95%CI value. Results A total of 7 963 people were included in the study. After a median follow-up of 6.50 years, a total of 202 people suffered or died of stroke disease. The incidence density was 3.62 per 1 000 person-years. Analysis of competing risk models adjusted for associated factors showed that no correlation was found between resting heart rate (RHR) and the incidence of all types of stroke in the non-hypertensive population. In the hypertensive population, the risk of stroke and ischemic stroke incidence was 1.896 for the RHR <76 beats/min group when RHR was ≥76 beats/min (SHR=1.896, 95%CI: 1.170 to 3.072) and 2.585 (SHR=2.585, 95%CI: 1.400 to 4.764) times greater than the risk of developing hemorrhagic stroke (SHR=0.919, 95%CI: 0.428 to 1.974). Conclusion RHR is not correlated with the occurrence of stroke in the non-hypertensive population, and controlling RHR to less than 76 beats/min will effectively reduce the risk of stroke and ischemic stroke development in the hypertensive population.