Correlation Between H-type Hypertension,leukoaraiosis And Post-stroke Cognitive Impairment

Objectives Hypertension and hyperhomocysteinemia are risk factors of cerebrovascular diseases.In China,the proportion of hyperhomocysteinemia is high in adult with hypertension.The onset of leukoaraiosis is occult,which is the most common imaging manifestations of cerebrovascular disease and can lead to motor dysfunction,mental abnormality and cognitive dysfunction.This study intends to explore the relationship between H-type hypertension(hypertension with hyperhomocysteinemia)and leukoaraiosis,and whether there is a synergistic effect between hypertension and hyperhomocysteinemia,further explore the independent influencing factors of leukoaraiosis.This study also intends to explore the correlation among H-type hypertension,leukoaraiosis and cognitive impairment after first-ever ischemic stroke,the incidence of early PSCI(3 months after first-ever ischemic stroke)in patients with H-type hypertension and the characteristics of cognitive function,and the independence influencing factors of PSCI at 3 months after first-ever ischemic stroke.Methods Patients hospitalized in the department of neurology,the second affiliated hospital of Nantong University from April 2018 to October 2019,including patients with non-cerebral infarction or first-ever ischemic stroke,were collected.Sociodemographic,serological indicators such as homocysteine,ambulate blood pressure results,and brain MRI were recorded for all enrolled patients.Cognition of patients with first-ever ischemic stroke was assessed by the Montreal cognitive assessment(Mo CA)at admission and at 3-month and 6-month follow-up.(1)According to blood pressure and serum homocysteine(Hcy),all patients were divided into four groups:H-type hypertension group(H-type HBP group),simple hypertension group(simple HBP group),simple hyperhomocysteinemia group(simple HHcy group)and control group(without hypertension and hyperhomocysteinemia).(1)The differences of leukoaraiosis score among four groups were compared,and the differences between acute cerebral infarction and non-acute cerebral infarction patients were compared.Spearman correlation coefficient was used to analyze the correlation between blood pressure and leukoaraiosis in non-acute cerebral infarction patients.(2)The clinical data of the four groups with first-ever ischemic stroke were compared,as well as the incidence of PSCI and Mo CA score at 3 months after cerebral infarction.Spearman correlation coefficient was used to analyze the correlation between serum Hcy?ambulate blood pressure and cognitive function at 3 months after stroke.(2)According to Fazekas score,0 point was classified as no leukoaraiosis group(no LA group),1-2 points as mild leukoaraiosis group(mild LA group),3-4 points as moderate leukoaraiosis group(moderate LA group),and 5-6 points as severe leukoaraiosis group(severe LA group).(1)The clinical data of four groups of patients were compared,and logistic regression analysis was used to determine the independent influencing factors of leukoaraiosis.(2)The incidence of PSCI and Mo CA score at 3 months after first-ever ischemic stroke of the four groups were compared.Spearman correlation coefficient was used to analyze the correlation between leukoaraiosis and cognitive function at 3 months after cerebral infarction.(3)Repeated measurement variance analysis and chi-square test were used to analyze the changes of Mo CA score and PSCI incidence over time after first-ever ischemic stroke.(4)According to Mo CA score at 3 months after cerebral infarction,patients were divided into 2 groups:early post-stroke cognitive impairment group(PSCI group)and normal cognitive function early after stroke group(N-PSCI group).The clinical data of the two groups were compared,and logistic regression analysis was used to determine the independent influencing factors of PSCI at 3 months after first-ever ischemic stroke.Results(1)The 24-hour mean systolic blood pressure(?=0.295,P=0.001),pulse pressure(?=0.400,P<0.001),and morning peak systolic blood pressure(?=0.259,P=0.003)in non-cerebral infarction patients were positively correlated with the severity of leukoaraiosis.The 24-hour mean pulse pressure(?=-0.139,P=0.026),systolic blood pressure variation coefficient(?=-0.243,P=0.000),diastolic blood pressure variation coefficient(?=-0.242,P=0.000)in patients with first-ever ischemic stroke were negatively correlated with the total Mo CA score at 3 months after stroke.(2)Hypertension were independent risk factors of mild(OR=7.513,95%CI 2.779-20.312,P<0.001), moderate(OR=16.183,95%CI 5.163-50.724,P<0.001)and severe(OR=24.168,95%CI3.969-147.175,P=0.001)leukoaraiosis.Hypertension was further divided into simple hypertension and H-type hypertension.Simple hypertension(OR=12.883,95%CI 3.786-43.835,P<0.001;OR=33.118,95%CI 8.280-132.462,P<0.001;OR=42.273,95%CI 3.757-475.693,P=0.002)was an independent predictor of mild,moderate and severe leukoaraiosis,while H-type hypertension was an independent predictor of severe leukoaraiosis(OR=19.395,95%CI 1.609-233.804,P=0.020),and simple HHcy was not an independent predictor of leukoaraiosis(OR=4.083,95%CI0.140-119.373.804,P=0.414).H-type hypertension(OR=4.591,95%CI 2.363-8.921,P<0.001)and simple hypertension(OR=2.613,95%CI 1.483-4.603,P=0.001)were independent risk factors of deep white matter leukoaraiosis.(3)Mo CA scores of patients with first-ever ischemic stroke decreased within 3 months after onset,and then increased within 6 months(F _a=7.551,P _a=0.001),and the effect of time factor does not vary with the grouping(H-Type HBP group,simple HBP group,simple HHcy group and control group).The incidence of PSCI increased gradually after first-ever ischemic stroke,peaked at 3 months,and then decreased gradually(?_b~2=6.321,P_b=0.042).(4)Hypertension(OR=6.824,95%CI 1.580-29.464,P=0.010)and serum Hcy(OR=1.253,95%CI1.034-1.519,P=0.021)were independent risk factors of PSCI 3 months after first-ever ischemic stroke.Take hypertension and HHcy together,H-type hypertension(OR=19.967,95%CI 5.395-73.906,P<0.001)?simple hypertension(OR=3.359,95%CI 1.250-9.029,P=0.016)were independent risk factors for PSCI at 3 months after cerebral infarction,while simple HHcy(OR=3.291,95%CI0.414-26.189,P=0.260)were not.The correlation between H-type hypertension and early PSCI was greater than the sum of simple HBP and simple HHcy.The serum Hcy level was divided into H1(5.8-9.9?mol/L),H2(10.0-12?mol/L),H3(12.1-14.9?mol/L)and H4(15.0-94.6?mol/L)by the quartering method.With H1 as reference group,H2(OR=2.647,95%CI 1.021-6.859,P=0.045)?H3(OR=3.136,95%CI 1.147-8.574,P=0.026)?H4(OR=9.278,95%CI 1.928-44.646,P=0.005)were positively correlated with PSCI independently,and the correlation became stronger with the increase of serum Hcy level.Leukoaraiosis Fazekas score(OR=1.971,95%CI 1.448-2.684,P<0.001)was an independent risk factor of PSCI,further analysis showed that deep white matter Fazekas score(OR=2.282,95%CI 1.222-4.259,P=0.010)was an independent risk factor for PSCI,while paraventricular Fazekas score(OR=1.383,95%CI 0.726-2.637,P=0.324)was not.Conclusions Hypertension is an independent risk factor of leukoaraiosis.Simple HHcy has little effect on leukoaraiosis,while when HHcy co-exists with hypertension,HHcy will strengthen the effect of hypertension on leukoaraiosis(especially deep white matter leukoaraiosis).The severity of leukoaraiosis was positively correlated with 24-hour mean systolic blood pressure,pulse pressure and morning peak systolic blood pressure.Hypertension and serum Hcy are both independent risk factors of PSCI at 3 months after first-ever ischemic stroke,and have a synergistic effect.The mean pulse pressure,systolic blood pressure/diastolic blood pressure variation coefficient in acute stage of cerebral infarction were negatively correlated with the total Mo CA score at 3 months after stroke.Serum Hcy?10.0?mol/L was positively correlated with the incidence of PSCI at 3 months after first-ever ischemic stroke,and with the increase of serum Hcy level,the correlation between serum Hcy and PSCI was stronger.Leukoaraiosis is an independent risk factor for early PSCI.The relationship between deep white matter Fazekas score and early PSCI was stronger than the total score of Fazekas score.