| Objective⑴To observe the differences in the acute blood pressure course among different ischemic stroke subtypes that not to be lower blood pressure.⑵To clarify the different causes of hypertension in acute ischemic stroke on prognosis.Methodstwo hundred and sixty-nine consecutive patients who were hospitalized within 48 hours in the Affiliated KaiLuan Hospital of Hebei United University and were diagnosed acute ischemic stroke were registered prospectively. Their baseline data were collected. According to the patient's clinical manifestations, the results of medical imaging and related auxiliary examinations , refer to improved TOAST points standard of ischemic stroke type, all patients were divided into four groups: Atherosclerosis,Cardioembolism,Small-artery diseases,Stroke of other determined etiology and Stroke of undetermined etiology . To study the blood pressure levels during the initial 14 hospital days. death and dependency(BI<85 or mRS>2) were assessed at 3 months. Relationship between BP in different time periods and death /dependency rate of three month was analyzed. Spearman's correlation analysis was used to analyze Factors relations to death /independent rate . Results⑴Three hundred and twelve consecutive patients who were hospitalized in the Affiliated KaiLuan Hospital of Hebei United University from From January 2010 to December 2010 and were diagnosed acute ischemic stroke were registered prospectively. There are two hundred and sixty-nine patients were followed up at there month. Lost access rate is 13.78%. There are one hundred and two patients of Atherosclerosis type(37.9%),twenty-seven patients of Cardioembolism type(10%), eighty-three patients of Small-artery diseases type(30.9%), fifty-seven patients of Stroke of other determined etiology and Stroke of undetermined etiology type(21.2%).⑵History of hyperlipidemia was significantly associated with ischemic stroke subtypes .There are about 85.9 percent of the patients with hyperlipidemia in Atherosclerosis type ,significantly higher than the other three groups. the difference was statistically significant (P<0.01). History of heart disease was significantly associated with ischemic stroke subtypes .There are about 89.9 percent of the patients with heart disease in Cardioembolism type ,significantly higher than the other three groups. the difference was statistically significant (P<0.05). NIHSS scores on on admission of patients with Small-artery diseases was lower than the other three groups , the difference was statistically significant (P<0.05). The other clinical datas were not found to be statistically significantly (P <0.05).⑶High blood pressure course in patients of these four groups with acute ischemic stroke were observed. The mean SBP on admission in patients with Atherosclerosis was 159.71±21.54mm Hg, The mean DBP was 91.92±11.39mm Hg.Mean SBP decreased 17.61±9.13 mm Hg within 24 hours of admission, mean DBP decreased 7.55±0.75 mm Hg. Mean SBP decreased 22.88±5.2 mm Hg at 3 days after admission, mean DBP decreased 9.31±3.79 mm Hg. Mean SBP decreased 26.33±9.58 mm Hg at 14 days after admission, mean DBP decreased 11.92±5.50 mm Hg. The mean SBP on admission in patients with Cardioembolism is 161.2±22.89mm Hg, The mean DBP was 93.8±11.82mm Hg.Mean SBP decreased 21.69±10.15 mm Hg within 24 hours of admission, mean DBP decreased 7.73±0.72 mm Hg. Mean SBP decreased 27.6±7.31 mm Hg at 3 days after admission, mean DBP decreased 11.17±3.9 mm Hg, Mean SBP decreased 28.2±5.8 mm Hg at 14 days after admission, mean DBP decreased 11.4±7.48 mm Hg. The mean SBP on admission in patients with Small-artery diseases is 158.59±20.91mm Hg, The mean DBP was 91.67±11.37mm Hg.Mean SBP decreased 18.08±8.24 mm Hg mm Hg within 24 hours of admission, mean DBP decreased 7.7±0.73 mm Hg. Mean SBP decreased 21.16±4.44 mm Hg at 3 days after admission, mean DBP decreased 9.13±3.85 mm Hg, Mean SBP decreased 22.59±5.82 mm Hg at 14 days after admission, mean DBP decreased 11.67±5.71mm Hg. The mean SBP on admission in patients with Stroke of other determined etiology and Stroke of undetermined etiology is 158.62±20.11mm Hg, The mean DBP was 91.24±11.11mm Hg.Mean SBP decreased 17.63±7.8 mm Hg within 24 hours of admission, mean DBP decreased 7.26±0.58 mm Hg. Mean SBP decreased 23.64±3.49 mm Hg at 3 days after admission, mean DBP decreased 8.61±3.56 mm Hg, Mean SBP decreased 23.02±5.49 mm Hg at 14 days after admission, mean DBP decreased 11.37±5.64 mm Hg. The SBP and DBP course and decrease in mean blood pressure in patients of these four groups have no significant differences .⑷A J-shaped relationship was found between the mean SBP and DBP on admission and death/dependency rate at 3 months after onset in patients of these four groups. High SBP and DBP values are associated with a poor prognosis. The prognosis was good when SBP on admission in the 140mmHg ~ 170mmHg, DBP in the 80mmHg ~ 90mmHg, the blood pressure on admission during acute ischemic stroke carried the best prognosis was 155/85 mmHg or so. This best blood pressure in patients of these four groups have not significant differences . A U-shaped relationship was found between the mean SBP and DBP on within 24 hours of admission and death/dependency rate at 3 months after onset in patients of these four groups. High or low SBP and DBP values are associated with a poor prognosis. The prognosis was good when SBP on admission in the 140mmHg ~ 170mmHg, DBP in the 80mmHg ~ 90mmHg, the blood pressure on within 24 hours of admission during acute ischemic stroke carried the best prognosis was 155/85 mmHg or so. This best blood pressure in patients of these four groups have not significant differences . A U-shaped relationship was found between the mean SBP and DBP at 2-3 days hospital and death/dependency rate at 3 months after onset in patients of these four groups. The prognosis was good when SBP on admission in the 140mmHg ~ 170mmHg, DBP in the 80mmHg ~ 90mmHg, the blood pressure at 2-3 days hospital during acute ischemic stroke carried the best prognosis was 155/85 mmHg or so. This best blood pressure in patients of these four groups have not significant differences . A U-shaped relationship was found between the mean SBP and DBP at 4-14 days hospital and death/dependency rate at 3 months after onset in patients of these four groups. The prognosis was good when SBP on admission in the 120mmHg～140mmHg, DBP in the 70mmHg～90mmHg, the blood pressure at 4-14 days hospital during acute ischemic stroke carried the best prognosis was 130/80 mmHg or so. This best blood pressure in patients of these four groups have not significant differences .⑸Spearman's correlation analysis was used to analyze risk Factors relations to death /independent rate at 3 months after onset. The results show that NIHSS score admission, male gender, hyperlipidemia,SBP decreased within 24 hours of admission were significantly associated with death/dependency rate at 3 months after onset in Atherosclerosis type(P<0.05). NIHSS score admission, fmale gender,age, SBP decreased within 24 hours of admission were significantly associated with death/dependency rate at 3 months after onset in Cardioembolism type(P <0.05). NIHSS score admission, hypertension, diabetes were significantly associated with death/dependency rate at 3 months after onset in Small-artery diseases type(P<0.05). NIHSS score admission was significantly associated with death/dependency rate at 3 months after onset in Stroke of other determined etiology and Stroke of undetermined etiology type (P<0.05).Conclusion⑴Blood pressure change in different causes of acute ischemic stroke are almost no different.⑵The relationship between the blood pressure of acute ischemic stroke in the same time period and death/dependency rate at 3 months after onset is the same,and the best blood pressure is same too.⑶SBP decreased within 24 hours of admission were significantly associated with death/dependency rate at 3 months after onset in Atherosclerosis type and Cardioembolism type. |
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