| Objective:Objective to explore the effect of blood pressure intervention time window on short-term prognosis(3m ± 7d)in patients with acute ischemic stroke(AIS)(no intravenous thrombolytic)complicated with essential hypertension and acute hypertensive response in the real world.To explore the changes of blood pressure in patients with AIS at acute stage and analyze the risk factors affecting the prognosis of patients.Methods:From March 2020 to December 2020,139 patients(remove the lost cases)with AIS complicated with essential hypertension and acute hypertensive response were collected(no intravenous thrombolytic).The general and clinical data of the patients were recorded,and the patients were followed up 3 months(3m±7d)after discharge to obtain the prognosis data.According to the time window from onset of AIS to first hypotension(Ti),the patients were divided into group A(T1≤60h)with 66 cases and group B(60h<T1≤4d)with 73 cases.And according to the time window from onset of AIS to recovery of long-term hypotension(T2),patients in group B were divided into group B1(T2≤5d)with 25 cases and group B2(5d<T2≤14d)with 48 cases.The short-term(3m±7d)mortality,poor prognosis,adverse event rate,functional outcome and treatment efficiency were compared between group A and group B,group Bi and group B2 through statistical methods.Results:1.There was no significant difference in age,gender,nationality,body mass index(BMI),past history,smoking history,drinking history and the admission NIHSS score between group A and group B,group B1 and group B 2(P>0.05),there were comparability.There were significant differences in short-term poor prognosis rate(χ2=8.564,P=0.003)and effective rate(χ2=7.540,P=0.006)between group A and group B(P<0.05),the poor prognosis rate of group A was higher than group B and the effective rate of group B was higher than group A.There were no significant differences in mortality(P=0.308a),adverse events(χ2=3.476,P=0.062)and moderate to severe dysfunction(χ2=1.962,P=0.161)between the two groups(P>0.05).There was significant difference in adverse events between group B1 and group B2(P>0.05).The incidence of adverse events in group B2 was higher than group B1,and the rate of stroke in group B2 was higher than group B1(P=0.045b,P<0.05).There were no significant differences in mortality(P=0.547b),poor prognosis(χ2=1.906a,P=0.167),treatment efficiency(χ2=0.440a,P=0.507)and moderate to severe dysfunction(P=0.410b)between the two groups(P>0.05).2.The blood pressure of AIS patients decreased gradually within 7 days after admission,the systolic blood pressure(SBP)gradually decreased to normal level in about 7 days,and the diastolic blood pressure(DBP)dropped to normal level in about 1 day.The morning blood pressure of the poor prognosis group was slightly lower than the good prognosis group,but the difference was not statistically significant(P>0.05).The range and amplitude of blood pressure fluctuation in the poor prognosis group were slightly larger than the good prognosis group,the difference was not statistically significant(P>0.05).The mean morning blood pressure at 7 days of poor prognosis group was slightly lower than the good prognosis group,the difference was not statistically significant too(P>0.05).3.Univariate analysis showed that the mean blood pressure at 7 days(t=2.098,P=0.039),age(U=1037.500,P<0.001),smoking history(χ2=4.315,P=0.038),hemoglobin(HGB)(t=2.940,P=0.005),albumin(ALB)(t=2.818,P=0.006),modified Rankin score(mRS)at admission(U=606.500,P<0.001),National Institute of Health stroke scale score(NIHSS)at admission(U=877.500,P<0.001),NI HSS at discharge(U=701.000,P<0.001),and time window T1(χ2=8.564,P=0.003)may be important factors affecting the short-term(3m±7d)prognosis(P<0.05).Multivariate logistic regression analysis showed that age(P=0.011,OR=1.109,95%CI:1.024～1.201)and the NIHSS at discharge(P=0.017,OR=1.388,95%CI:1.061～1.817)were risk factors for poor short-term(3m±7d)prognosis.Conclusion:1.The time window of hypotension will affect the short-term(3 m±7d)prognosis of AIS patients with essential hypertension and acute hypertensive response.When the time window from onset of AIS to first hypotension less than 60 hours,the risk of poor prognosis will increase and the effectiverate of treatment will reduce.The time window from onset of AIS to recovery of long-term hypotension more than 5 days will increase the incidence of adverse events,the incidence of recurrent stroke is increased significantly.So when the condition is stable,starting or resuming long-term hypotension within 60 hours to 5 days may be beneficial to the short-term prognosis of this patients.2.The time window of hypotension did not affect the short-term mortality and functional outcome.3.The blood pressure of AIS patients with essential hypertension and acute hypertensive response decreased gradually within 7 days after admission,and SBP gradually decreased to normal level about 7 days.4.The blood pressure trajectory of patients with poor prognosis tends to be slightly lower than the patients with good prognosis within 7 days after admission,but the natural fluctuation of blood pressure may not affect the short-term prognosis.5.Advanced age and high discharge NIHSS score are risk factors for poor short-term prognosis。... |
PDF Full Text Request