| Part 1 Study of blood pressure variation and independent factors related to BP levels of patients with acute strokeObjective: To explore the blood pressure variation and influential factors in patients with acute strokeMethod: We studied 499 consecutive inpatients admitted within the first 24 hours after the onset of stroke. we collected the basic information ,monitored the blood pressure values during the first 7 hospital days ,graded the companion diseases ,recorded the ways and the time of managing blood pressure .The data was analysed with SPSS statistic software .Results:(1)Blood pressure elevated in initial stage of acute stroke .It decreased distinctively during the first 16 hours, especially the first 8 hours, and changed smoothly from 16 hours to 36 hours after admission. The BP at 28 hours after admission reached a stable level in the group with ischemic stroke.In hemorrhagic stroke,BP at 92 hours after admission reached a stable level. (2)Blood pressure in acute stage of cerebral hemorrhage was higher than that of brain infarction.(3)Blood pressure variation had no difference among five brain infarction subgroups.(4)Blood pressure of stroke patients with hypertension history was higher than that of normotensive patients in acute stage.(5)Multiple linear regression analysis revealed that history of hypertension and scores of NIHSS were positively related with admission blood pressure ,while scores of anamnesis and cardiac disease were negatively related with admission diastolic blood pressure in patients with acute stroke .The age was positively related with the admission SBP but negatively with admission DBP. Consciousness on admission was only related with admission SBP. And the scores of NIHSS,history of hypertension,Consciousness on admission,scores of companion diseases,type of stroke and aggravation in 7 days were positively related with the mean blood pressure during the first 7 days.The cardiac disease was negatively with mean BP during the first 7 days.Conclusion: Blood pressure usually elevated in patients with acute stroke, it decreased distinctively during the first 16 hours, and changed smoothly from 16 hours to 36 hours after admission. Blood pressure was higher in those patients who were cerebral hemorrhage, who had hypertension previously and more companion diseases than others at acute stage of stroke .Part 2 Study of the relationship between blood pressure and prognosis in patients with acute strokeObjective: To explore the relationship between blood pressure and prognosis in patients with acute stroke and provide guidance for clinical treatment .Method: We studied 499 consecutive inpatients admitted within the first 24 hours after the onset of stroke. we collected the basic information ,monitored the blood pressure values during the first 7 hospital days ,graded the companion diseases ,recorded the ways and the time of managing blood pressure Stroke severity was measured with National Institutes of Health Stroke Scale(NIHSS)on admission and 6-month visits. The functional outcome was assessed on the basis of mortality or dependency(Barthel Index ,BI <60)at the 6-month visits. The data was analysed with SPSS statistic software.Result: (1)A U-shaped relationship was found between BP on admission,the first day, as well as mean BP during the first 7 days ,and functional outcome at the 6-month visits in patients with acute stroke . Those who had a BP of 150/85mmHg would have a better functional outcome, those who had higher or lower BP would have a poor functional outcome.(2)A U-shaped relationship was only found between SBP on admission and the prognosis at the 6-month visits in the group of cerebral infarction. There was no U-shaped relationship between BP and prognosis in the group of cerebral hemorrhage(.3)Those who had a high PP(pulse presure PP) would have a poor prognosis(.4)Those who had greater blood pressure variation would have poor prognosis(.5)Logist regression analysis revealed that the mean BP during the first day ,the mean SBP during the first 7 days,scores of companion diseases ,deterioration within 7 days after admission,scores of NIHSS on admission was related with high rate of mortality or dependency.Conclusion:A U-shaped relationship was found between BP and prognosis in patients with acute stroke . Prognosis was better when SBP varied from 120 to 180mmHg and DBP varied from 70 to 100mmHg.When studied according to stroke type ,we can speculate that there was no clear U-shaped relationship between BP and prognosis. In cerebral infarction group there wes a L-shaped relationship between BP and prognosis,that meant that Those who had higher BP would have better prognosis. In cerebral hemorrhage group there wes a J-shaped relationship between BP and prognosis,that meant that those who had lower BP would have better prognosis in cerebral hemorrhage. So we speculate that high BP was advocated to decrease placidly in patients of cerebral hemorrhage,while in patients of cerebral infarction should be cautiously. |
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