Change In Blood Pressure And Its Relation With Prognosis Of Acute Stroke

Part 1Study of blood pressure variation and independent factors related to BP levels of patients with acute strokeObjective:To explore the blood pressure variation and influential factors in patients with acute strokeMethod:We studied 704 consecutive inpatients admitted within the first 24 hours after the onset of stroke. And then we monitored the blood pressure values during the first 7days, collected the basic information, graded the companion diseases., recorded the ways and the time of managing blood pressure. The primary endpoint was death and death/disability at 3 and 6 months after the admission. The data was analyzed with SPSS statistic software.Results:(1) Blood pressure elevated in initial stage of acute stroke, especially the systolic blood pressure(about 79.7%>140mmHg), It decreased distinctively during the first 8 hours, especially the first 8 hours, and gradually became stable until 36 hours after admission.(2) Patients with hemorrhagic stroke had significantly higher SBP and DBP than those with ischemic stroke(P=0.000). After 92 hours the former reached a stable level, and the latter after 30 hours. (3) Blood pressure variation had no difference among subgroups according to TOAST and OCSP. (4)Neurologic impairment degree had effect on the admission BP and following BP until 36 hour. The successive variation among the 7 days is higher in the severe neurologic group. (5)The one who had took hypotensive medicine daily had the lower BP then the not ones. In acute period stopped to take hypotensive drug is not the reason that blood pressure became higher. (6) Independent factors related to admission SBP were:stroke type, admitted NIHSS score, the history of heart disease, hypertension. Independent factors related to admission DBP were:stroke type, age, admitted NIHSS score, hypertension. Conclusion:Blood pressure usually elevated in patients with acute stroke, and decreased gradually. Patients with hemorrhagic stroke had significantly higher SBP and DBP than those with ischemic stroke. Neurologic impairment degree had effect on the admission BP and following BP until 36 hour. Independent factors related to admission BP were:stroke type, admitted NIHSS score, heart disease, hypertension.Part 2Study of the relationship between blood pressure and prognosis in patients with acute strokeObjective:To explore the relationship between blood pressure and prognosis in patients with acute stroke.Method:We studied 704 consecutive inpatients admitted within the first 24 hours after the onset of stroke. we collected the basic information,monitored the blood pressure values during the first 7 days,graded the companion diseases,recorded the ways and the time of managing blood pressure Stroke severity was measured with National Institutes of Health Stroke Scale (NIHSS) on admission and 6-month visits. The functional outcome was assessed on the basis of mortality or dependency (Barthel Index,BI<60) at the 6-month visits. The data was analysed with SPSS statistic software.Result:(1) A J-shaped relationship was found between BP and 6-month death and death/dependency, especially with the SBP. When SBP level between 120-180 mmHg (mean 150mmHg) had a better outcome. (2)In the group of cerebral infarction, we found a L-shaped relationship between admission SBP and 6-month prognosis. While in the group of cerebral hemorrhage, there is a J-shaped relationship. (3) A J-shaped relationship was found between the severe neurologic impairment degree group and 6-month prognosis. (4)A n-shaped relationship was found between degression rate in 24 hours and prognosis. The rate between 15%-20% had a better prognosis. The higher the successive variation among the 7 days, the bad the 6-month prognosis. Logist regression analysis revealed that the mean SBP during the first day, the mean SBP during the first 7 days, the DBP successive variation among the 7 days, the degression rate in 7 days, age, scores of companion diseases,deterioration within 7 days after admission, scores of NIHSS on admission were related with high rate of mortality or dependency.Conclusion:A J-shaped relationship was found between BP and prognosis in patients with acute stroke. A L-shaped relationship between admission SBP and 6-month prognosis was found in cerebral infarction group. So we maybe should depress the BP cautiously in cerebral infarction group. While in the group of cerebral hemorrhage, there is a J-shaped relationship. We maybe can depress the BP moderately. The degression rate in 24 hours between 15%-20% had a better prognosis. The higher the successive variation during the 7 days, the bad the 6-month prognosis. Factors that effects the 6-month prognosis are the mean BP during the first and seven days, successive variation, degression rate, scores of companion diseases,deterioration within 7 days after admission and scores of NIHSS on admission.