Analysis Of H-type Hypertension And Clinical Characteristics Of Ischemic Cerebrovascular Disease

Objective:To analyze the effect of H-type hypertension on patients with ischemic cerebrovascular disease through retrospective study,and further explore the relationship between them from the aspects of neurological impairment degree,TOAST etiological classification,carotid atherosclerosis,etc.,so as to provide valuable guidelines for the prevention and treatment of cerebrovascular disease.Methods:In this study,260 patients with acute cerebral infarction who were treated in the Neurology Department of the Lequn District of the First Hospital of Jilin University from2021 to 2022 and 64 healthy people who were physically examined during the same period served as the research objects.The clinical data of all subjects were collected,including gender,age,history of smoking and alcohol consumption,history of hypertension,history of diabetes and relevant laboratory examination indicators,such as Homocysteine（Hcy）,folic acid,vitamin B₁₂,total cholesterol,triglyceride,high density lipoprotein,low density lipoprotein,etc..A comparison and analysis of the general data of patients in the cerebral infarction group and the normal group was conducted.Then,according to the plasma Hcy inspection results and the presence of hypertension,the cerebral infarction patients were divided into four groups:H-type hypertension group,hypertension group,hyperhomocysteinemia group and control group with no hypertension or hyperhomocysteinemia.The degree of neurological impairment,TOAST etiological classification,carotid atherosclerosis and other aspects were compared to analyze the correlation between H-type hypertension and the clinical characteristics of ischemic cerebrovascular disease.Results:1.The general data of patients in the cerebral infarction group and the normal group were compared.There were 260 patients in the cerebral infarction group,including 184males（70.8%）,76 females（29.2%）,with an average age of 61.94±11.26 years,137smokers（52.7%）and 116 drinkers（44.6%）.There were 64 patients in the normal group,including 32 males（50.0%）and 32 females（50.0%）,with an average age of 63.86±11.43years,23 smokers（35.9%）and 22 drinkers（34.4%）.There were statistical differences in the ratio of male to female and smoking（P<0.05）,but no statistical differences in age and drinking between the two groups（P>0.05）.There were 239 patients with cerebral infarction complicated with hypertension（91.9%）,108 patients with H-type hypertension（41.5%）and 80 patients with diabetes（30.8%）.There were 37 patients with hypertension（57.8%）in the normal group,10patients with H-type hypertension（15.6%）and 8 patients with diabetes（12.5%）.There were significant statistical differences in the prevalence of hypertension and H-type hypertension between the two groups（P<0.001）,as well as a statistical difference in the occurrence of diabetes（P<0.05）.The level of Hcy（umol/L）in the cerebral infarction group was 13.8（11.03,20.03）,which was higher than that in the normal group 12.0（8.68,14.78）,and folic acid level（ng/ml）in the cerebral infarction group was 3.89（2.80,6.01）,which was lower than that in the normal group 5.12（3.29,6.01）.The Vit B₁₂level（pg/ml）of 367.5（292.25,494.0）was lower than that of the normal group 480.0（356,625）.There were significant statistical differences between the two groups in Hcy and Vit B₁₂levels（P<0.001）,and in folic acid level（P<0.05）.There were no significant differences in TC,TG,HDL and LDL levels（P>0.05）.2.Multivariate Logistic regression analysis showed that hypertension and diabetes were independent risk factors for cerebral infarction,and Vit B₁₂level was an independent protective factor for cerebral infarction.3.The NIHSS scores of the four groups at admission were calculated respectively for comparison,and the score of NIHSS in the H-type hypertension group was 6.0（4.0,8.0）.The NIHSS score of the hypertension group was 4.0（2.0,6.0）.The NIHSS score of the HHcy group was 4.0（0.0,8.0）.The NIHSS score of the control group was 2.0（1.75,4.0）.Among them,the H-type hypertension group had the highest NIHSS score,and the difference between groups was statistically significant（P<0.001）.4.According to the age,patients with cerebral infarction were divided into three groups:young,middle-aged and old.The occurrence of H-type hypertension among the three groups was compared.There were 24 young patients with cerebral infarction,including 7 patients with H-type hypertension（29.1%）,9 patients with simple hypertension（37.5%）and 4 patients with simple HHcy（16.7%）.Among the 71 patients in the middle-aged cerebral infarction group,there were 24 cases（33.8%）with H-type hypertension,39 cases（54.9%）with simple hypertension and 2 cases（2.8%）with simple HHcy.There were 165 patients in the elderly cerebral infarction group,including 77patients with H-type hypertension（46.7%）,83 patients with simple hypertension（50.3%）and 1 patient with simple HHcy（0.6%）.Among them,the incidence of H-type hypertension was the highest in the elderly patients,and the difference between the three groups is statistically significant（P<0.001）.Further calculation showed that the Hcy level of young cerebral infarction group was 21.66±24.39,that of middle-aged cerebral infarction group was 20.60±19.94,and that of old cerebral infarction group was 18.57±11.86.The Hcy level in the young cerebral infarction group was higher than that in the middle-aged and old cerebral infarction group.5.The distribution of TOAST etiological types in the four groups was compared.There were 60 cases of LAA type（55.5%）,46 cases of SAA type（42.6%）and 2 cases of other types（1.9%）in the H-type hypertension.In the hypertension group,there were 66cases（50.4%）of LAA type,60 cases（45.8%）of SAA type and 5 cases（3.8%）of other types.In the HHcy group,there were 2 cases of LAA type（28.6%）,4 cases of SAA type（57.1%）and 1 case of other type（14.3%）.In the control group,there were 4 cases of LAA type（28.6%）,7 cases of SAA type（50.0%）and 3 cases of other types（21.4%）.LAA type was dominant in both the H-type hypertension group and the hypertension group,and the prevalence of LAA type in the H-type hypertension group was higher than that in the other three groups,with a statistical difference（P<0.05）.6.The incidence of carotid atherosclerotic plaque among the four groups was compared.There were 97 cases（89.8%）with carotid atherosclerotic plaque in the H-type hypertension group and 106 patients（80.9%）in the hypertension group.In the HHcy group,there were 6 cases（85.7%）with carotid atherosclerotic plaque.In the control group,there were 9 patients（64.3%）with carotid atherosclerotic plaque.The plaque detection rates of the four groups were:H-type hypertension group>HHcy group>hypertension group>control group,and the difference between the groups was statistically significant（P<0.05）.7.The properties of carotid atherosclerotic plaques in the four groups were compared,there were 71 cases（73.2%）of H-type hypertension complicated with vulnerable plaques and 26 cases（26.8%）of stable plaques.In the hypertension group,there were 66vulnerable plaques（62.3%）and 40 stable plaques（37.7%）.HHcy combined with vulnerable plaque in 1 case（16.7%）and stable plaque in 5 cases（83.3%）.In the control group,there were 3 cases（33.3%）with vulnerable plaque and 6 cases（66.7%）with stable plaque.Among them,the H-type hypertension group had the highest incidence of vulnerable plaque.The difference between the four groups was statistically significant（P<0.05）.Further analysis with the additive model of epidemiological interaction showed that hypertension and HHcy had a synergistic effect in the formation of carotid vulnerable plaque（S=2.624>1）.Conclusions:1.The development of H-type hypertension is related to age,and commonly occurs in elderly patients.There may be a correlation between Hcy level and the occurrence of stroke in young adults.2.H-type hypertension is associated with the formation and progression of carotid atherosclerosis.Hypertension and HHcy play a synergistic role in the formation of vulnerable carotid plaques.3.It is further verified that hypertension and diabetes are independent risk factors for acute cerebral infarction,and Vit B₁₂level may be an independent protective factor.