Study On The Correlation Of H-type Hypertension And Prognosis Of Ischemic Stroke

Background and PurposeStroke has the characteristics of the high incidence, high mortality, high morbidity and high recurrence rate. Both in developing and developed countries, stroke is the first cause of disability. A large number of disabled patients after stroke have brought enormous economic and emotional burden to the family and society. Actively searching for the prognostic factors of stroke patients, thereby improving the prognosis and reduce disability become increasingly important. At present. the H-type hypertension which accompany with high homocysteine and the incidence of stroke has a clear relationship, but the relationship with stroke prognosis hasn’t established.The purpose of this study is to investigate the correlation between hypertension with hyperhomocysteinemia and prognosis of ischemic stroke.MethodsPatients with acute ischemic stroke confirmed by CT/MRI in the Neurology department of the First Affiliated Hospital of Zhengzhou University from1/1/2009to1/1/2011were registered. NIHSS (National Institute of Health Stroke Scale) score on admission. Record the baseline date of patients and probable risk factors for prognosis of ischemic stroke.Recovery was assessed by MRS (modified Rankin score) at6months follow-up. Statistics used multivariate Logistic regression analysis. Results634patients were enrolled and32Lost to follow-up.28(4.6%) cases died.197females (32.7%),405males (67.3%). There were343(57.0%) cases with hypertension,163cases (27.1%)with diabetes mellitus,142cases (23.4%)with hyperlipidemia,24cases with (4.0%) atrial fibrillation,17(2.8%) cases with coronary heart disease,37(6.1%) cases with TIA(Transient ischemic attack),117(19.4%)cases with stroke,208(34.6%)cases with smoking history, the range of age was (19～92) years, Average was(59±13) years; Average homocysteine was (19.09±11.19)μmol/L; fasting blood glucose range (3.00-25.57) mmol/L, average blood glucose was (6.11±2.69) mmol/L, admission of systolic blood pressure rang (90-210) mmHg, average systolic blood pressure was(143.85±20.79) mmHg, admission diastolic blood pressure range(57～160) mmHg, average diastolic pressure was(87.37±13.56) mmHg.523(86.9%) cases received antiplatelet therapies,35(5.8%) cases received anticoagulation, Chinese medicine treatment in514(85.4%) cases,127(21.1%) cases received rehabilitation. At6months follow-up,457(69%) cases with MRS<3,145(31%) cases with MRS>3.High hyperhomocysteinemia group and non-high hyperhomocysteinemia patients in age, gender, incidence of hypertension, the differences were statistically significant.Single factor analysis results show that the high blood pressure, high homocysteine, age, diabetes, hyperlipidemia, atrial fibrillation, stroke history, anti-platelet aggregation treatment, anticoagulant therapy, admission NIHSS, admission of fasting blood sugar, admission systolic blood pressure and diastolic blood pressure had correlation with6months prognosis. Logistic regression analysis showed when hyperhomocysteinemia cut off10μol/L, the H-type hypertension and ischemic stroke6months MRS had no correlation, high blood pressure and high homocysteine interact was no statistical difference; there was a significant association between and6months MRS of the patient(P=0.012, OR=2.566,95%CI:1.299～5.357) when we defined homocysteine is not less than15μmol/L forhyperhomo-cysteinemia, and there was a total sum of the interaction between hypertension and hyperhomocysteinemia (relative excess risk of interaction (RERI), attributable proportion due to interaction (AP), synergy index (S) For0.683,26.61%,1.59respectively. Other variables significantly correlative to prognosis were:Age, History of stroke, NIHSS score on admission, Diastolic blood pressure on admission.ConclusionsWhen we defined homocysteine is not less than15μmol/L for hyperhomocysteinemia the H-type hypertension and6month MRS of the patient have significant association, H-type hypertension is a risk factors for the prognosis of ischemic stroke,and when hypertension and hyperhomocysteinemia coexistence there is a total sum of interaction.