Effects Of Immediate Blood Pressure Reduction On Cognitive Function In Patients With Acute Ischemic Stroke And The Risk Factor Of Vci After Stroke

Objective1. To evaluate whether blood pressure reduction in patients with acute ischemic strokewould improve the cognitive function.2. To investigate the risk factors of cognitive dysfunction after stroke.Method1. Patients were recruited from hospital of the PLA88between September2011andMay2013. We conducted among204Patients with nonthrombolysed ischemic strokewithin48hours of onset and elevated systolic blood pressure randomly.Patients(n=104)were randomly assigned to receive antihypertensive treatment （aimat lowering systolic blood pressure by5%to10%within the first24hours afterrandomization, achieving blood pressure less than140/90mmHg within7days） or todiscontinue all antihypertensive medications(control) during hospitalization(n=100).After1year, we compared the difference of cognitive function and incidence of cognitivedysfunction after stroke between the two groups.2. Afer3and12months, we investigated the risk factors of cognitive dysfunction afterstroke with and evaluated the role of uric acid, homocysteine, c-reaction protein and pulsepressure in cognitive dysfunction after stroke with immediate blood pressure reduction.Result1. In3month, The score of MMSE and MoCA of the experimental group is(24.90±3.58) and (22.39±4.08), the control group is (22.23±4.52) and (19.41±4.62), thedifference is significant (p<0.05). The incidence of cognitive dysfunction after stroke ofexperient group is19.2%, The other group is35%. The difference is significant (p<0.05).2. In12month, The score of MMSE and MoCA the experimental group is(25.44±3.79) and(22.31±4.29), the control group is(20.74±4.57) and (18.23±5.10)，the difference is significant (p<0.05). The incidence of cognitive dysfunction after stroke ofexperient group is28.8%, The other group is55%. The difference is significant (p<0.05).3. Single factor analysis: There were significant differences in age, education level,diabetes, immediate blood pressure reduction, uric acid, homocysteine c-reactive protein,and pulse pressure (P<0.05) between VCI group and without VCI group. Logisticregression analysis: After adjustment for confounding with a model for multiple regressionanalysis, age, uric acid, homocysteine, c-reactive protein and pulse pressure were found tobe independent risk factors for VCI after stroke and immediate blood pressure reductionand high education level is a protect factors.4. The score of MMES and MoCA of the group with the increased uric acid in3and12month was worse than the control group. The difference was significant（p＜0.05）. Thescore of MMES and MoCA of the group with the increased c-reactive protein in3and12month was lower than the the control group. The difference was significant（p＜0.05）.Thescore of MMES and MoCA of the group with the increased homocysteine was lower thanthe control group both in3month and12month.The difference was significant（p＜0.05）.The score of MMES and MoCA of the group with the increased pulse pressure wasbelow the control group. The difference was significant（p＜0.05）.Conclusion1. The antihypertensive therapy of acute cerebral infarction can improve the cognitivefunction of the patient with hypertension in3month and12month.2. Immediate blood pressure reduction in patients with acute ischemic stroke canreduce the incidence of VCI after stroke.3. Age, uric Acid, homocysteine, c-reactive protein and pulse pressure were found tobe independent risk factors for VCI after stroke and immediate blood pressure reductionand high education level is a protective factor.4. Uric Acid, homocysteine, c-reactive protein and pulse pressure play a harmful rolein VCI after stroke with immediate blood pressure reduction.Research significanceThe research provided a wide range of real and detailed clinical data for us to knowthe relevance between cognitive function and immediate blood pressure reduction and theinfluence of different risk factors of cognitive function.our experiment proved that weshould take antihypertensive drugs for the patients diagnosed acute cerebral infarction withhypertension and offer reliable basis for the occurrence of cognitive impairment.