The Study On The Relationship Of Blood Pressure To Target Organ Damage And Prognosis Of Acute Stroke Patients

[Objective]Understanding of characteristics and diurnal variation of blood pressure rhythm in patients with acute stroke through using ambulatory blood pressure monitoring system. Analyze the relationship of diurnal rhythm of blood pressure with target organ damage and prognosis in patients with acute stroke. And using ambulatory blood pressure monitoring as a guide to institute individualized nursing interventions of blood pressure in patients with acute stroke.【Methods】October 2008—September 2009 admissions,265 cases in patients with acute stroke, of which 174 cases male, female 91 cases, mean age 63.47±12.68 years, all the patients during the blood pressure monitoring and the previous day not to use antihypertensive drugs. Survey tools include:German production MOBIL-O-GRATH ambulatory blood pressure monitoring system, the United States nerve function scale (NIHSS) score, quality of life score (Barthel Index score),Cardiac Doppler ultrasound instrument, Stroke Unit data system. The data were analyzed using statistical software processing, statistical methods included descriptive statistics, ANOVA single factor analysis of variance, t test andχ2 test.[Results]1.265 patients with acute stroke admitted to hospital 24-hour average systolic is (139.73±18.84) mmHg,24-hour mean diastolic blood pressure is (83.48±13.12) mmHg. Simple systolic blood pressure levels (SBP≥140mmHg) are 50 cases (18.9%), pure diastolic blood pressure levels (DBP≥90mmHg) are 11 cases (4.15%), mixed blood pressure levels (SBP≥140mmHg, DBP≥90mmHg) are 76 cases(28.7%). Nighttime average systolic blood pressure is (134.88±21.79) mmHg, mean diastolic blood pressure at night is (81.14±13.60) mmHg, nocturnal blood pressure decrease rate (SBP or DBP fall)> 10%(dipper blood pressure) are 80 cases (30%), nocturnal blood pressure decrease rate (SBP or DBP decrease)≤10% (non-dipper blood pressure) are 90 patients (34%), nocturnal blood pressure rise (anti-dipper blood pressure) in 95 cases (36%). The average morning systolic blood pressure is (141±12.21) mmHg, mean diastolic blood pressure morning is (86.19±15.02) mmHg, early morning blood pressure SBP≥140mmHg and DBP≥90mmHg are 88 patients (33.2%). Hypertension combined with brain injury alone are 88 patients (33.2%), with brain damage and left ventricular hypertrophy are 116 cases (43.8%), with brain damage, left ventricular hypertrophy and renal injury are 61 patients (23%).2. Dipper, non-dipper, anti-dipper blood pressure comparison:Three kinds of blood types of patients's early morning blood pressure, systolic blood pressure, pulse pressure at night, night systolic and diastolic blood pressure, diastolic blood pressure variability at night and 24h mean arterial pressure were statistically significant difference (P<0.05); three kinds of blood types of patients's high-density lipoprotein, triglyceride, high sensitive C-reactive protein were statistically significant difference (P<0.05);Three kinds of blood types of patients's target organ damage and improvement rate of neurological function and the quality of life after three months (NIHSS score and Barthel index scores), the difference was statistically significant (P<0.05).3. The effects of hypertension history, age and target organ damage on blood pressure in acute stroke patients:with a history of hypertension and without a history of in patients their early morning blood pressure,24-hour systolic blood pressure, diastolic blood pressure, pulse pressure was statistically significant difference (P <0.05); aged≥60 years and≤60 years in patients their early morning systolic blood pressure,24h pulse pressure, daytime pulse pressure, pulse pressure at night,24h systolic blood pressure,24h mean arterial pressure was statistically significant difference (P<0.05); Simple brain injury group, heart, brain injury group and the heart, brain, kidney injury group, three groups of patients's nocturnal pulse pressure, systolic blood pressure, diastolic blood pressure were significantly difference (P<0.05). 【Conclusion】1. Disappearance of circadian rhythm of blood pressure, the rising of nocturnal blood pressure and morning blood pressure is the main feature of acute stroke blood pressure.2.The disappearance of circadian rhythm of blood pressure in patients with more serious target organ damage and the prognosis of three months after discharge is also poor.3. Age, with a history of hypertension and target organ damage in stroke patients are acute blood pressure factors. Tips for medical person develop treatment, care measures of blood pressure in acute stroke patients should integrated to these factors. Nurses develop rational individual nursing interventions for acute stroke patients should according to the results of ambulatory blood pressure monitoring and the blood pressure circadian rhythm characteristics.