| BackgroundThe relationship between blood pressure in acute phase and the prognosis among ischemic stroke patients is till uncertain, there was few related reports with large sample in China.PurposeTo explore the relationship between blood pressure indexes in 3 days after admission and the discharge neurologic impairment or death during hospitalization among the acute ischemic stroke patients, to provide scientific evidence for the effective controlling of blood pressure in the acute ischemic stroke patients.MethodsA total of 2675 ischemic stroke patients in four hospitals in Shandong province from January, 2006 to December, 2008 were included in the present study. Data on demographic characteristics, life style risk factors, blood pressure in 3 days after admission, clinical laboratory tests, medical history, and study outcomes(NIHSS≥5 or death) were obtained using a standard questionnaire administered by trained stuff from medical records. Statistic analysis was conducted using SPSS16.0 software. Comparisons of the study outcome distribution and baseline characteristics at admission between the patients with study outcome and without study outcome were conducted, and odds ratios (ORs) and 95% confidence interval (95%CI) of study outcomes among patients with different blood pressures at admission and in 3 days after admission were calculated by using multiple logistic model, and linear tendency tests were conducted.Results1. Among 2675 ischemic stroke patients, the percentage of cerebral thrombus(73.4%) was higher than that of cerebral embolism (2.5%) and lacunar embolism (21.4%). The rate of study outcomes was higher in patients with cerebral embolism (37.3%)than that in those with cerebral thrombus(18.0%) and lacunar embolism(10.1%), P<0.05.2. After adjustment for gender, age, smoking, drinking, dyslipidemia, hyperglycemia, history of atrial fibrillation and history of rheumatic heart disease, compared to those with SBP of 120-139 mmHg, ORs of study outcome were 1.671(1.014,2.754),1.436(1.037,1.988) and 2.013(1.383,2.930) for ischemic stroke patients with SBP of 100-119,160-179 and≥180 mmHg,respectively, P<0.05. Based on SBP of 120-139 mmHg, risk of study outcome increased with SBP increasing or decreasing, there was a U shape relationship between admission SBP and study outcome.3. After adjustment for gender, age, smoking, drinking, dyslipidemia, hyperglycemia, history of atrial fibrillation and history of rheumatic heart disease, compared to those with DBP<90 mmHg, the OR of study outcome was 1.396(1.023,1.907) for the ischemic stroke patients with DBP of 100-109 mmHg at admission, P<0.05.4. After adjustment for gender, age, smoking, drinking, dyslipidemia, hyperglycemia, history of atrial fibrillation and history of rheumatic heart disease, compared to those with MAP<97 mmHg, ORs of study outcome were 1.448(1.053,1.991) and 1.580(1.158,2.156) for the ischemic stroke patients with MAP of 107-116 and≥117 mmHg at admission, respectively, all P<0.05, which implied that higher MAP at admission increased risk of study outcome among ischemic stroke patients.5. After adjustment for gender, age, smoking, drinking, dyslipidemia, hyperglycemia, history of atrial fibrillation and history of rheumatic heart disease, compared to those with PP of 50-59 mmHg, the ORs of study outcome were 1.826(1.316,2.535) and 1.863(1.370,2.534) for the ischemic stroke patients with admission PP<50 and≥66 mmHg, respectively, all P<0.05, Based on PP of 50-59 mmHg, risk of study outcome increased with PP increasing or decreasing, there was a U shape relationship between admission PP and study outcome.6. After adjustment for gender, age, smoking, drinking, dyslipidemia, hyperglycemia, history of atrial fibrillation and history of rheumatic heart disease, compared to those with average SBP<140 mmHg in 3 days after admission, OR of study outcome was 2.449 (1.227,4.892) for the ischemic stroke patients with average SBP≥180 mmHg; compared to those with average DBP<90 mmHg in 3 days after admission, ORs of study outcome were not significant for the patients with DBP of 90-99,100-109 and≥110mmHg, all P>0.05. Compared to those with average MAP<97 mmHg in 3 days after admission, ORs of study outcome were 1.414(1.009,1.983) and 1.483(1.065,2.063) for the ischemic stroke patients with average MAP of 104-110 and≥111 mmHg, respectively, P<0.05. Compared to those with average PP<48 mmHg in 3 days after admission, ORs of study outcome were not significant for the patients with MAP of 48-53,54-62 and≥63mmHg, all P>0.05.Conclusions1. The rate of study outcomes was higher in patients with cerebral embolism than that in those with cerebral thrombus and lacunar embolism.2. Risk of study outcome was the lowest for the ischemic stroke patients with admission SBP of 120-139 mmHg or PP of 50-59 mmHg. Based on SBP of 120-139 mmHg or PP of 50-59 mmHg, risk of study outcome increased with SBP or PP increasing or decreasing, there was a U shape relationship between admission SBP or admission PP and study outcome.3. Higher MAP at admission increased risk of study outcome among ischemic stroke patients;4. Higher SBP and MAP in acute phase(in three days after admission) could increase risk of study outcome among ischemic stroke patients... |
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