Study Of The Relationship Between Blood Pressure And Antihypertension Treatment And Early Prognosis In Patients With Acute Ischemic Stroke

ObjectiveObserve the change rule of blood pressure during the acute ischemic stroke patients. Study the relationship between blood pressure levels in the acute phase and prognosis.Explore the influence of acute cerebral infarction antihypertensive treatment on prognosis,to provide guidance for clinical treatment.MethodsConsecutively collecting cerebral infarction patients during August, 2009 to August,2010 in the second nerval medical department ward of Hebei United University Hospital.In total, 164 cases of patients had been selected according to the criteria.They were randomly divided into intervention group and control group.And we carried on the collection of primary data, dynamic monitoring of blood pressure changes of the two groups of patients within 14 days admission.The intervention group was given antihypertensive therapy. Treatment was targeted to a 10% to 20% blood pressure reduction within 24 hours （but SBP≥120mmHg, DBP≥80mmHg）, blood pressure in 7 days admission when reduced to 140/90mmHg below, 14 days inside blood pressure maintaining at this level. Observe the two groups of patients on admission and neurological impairment at 14 days, and record death.Follow up at 3 months, and record whether the stroke is occurring again during 3 months period, cardiovascular events （including myocardial infarction, heart failure） and renal failure.Statistic analysis was conducted using SPSS13.0 software.Measure- -ment data were analyzed by t-test between two groups.numeration data were analyzed byχ²-test.Relative risk（RR）and 95%confidence interval （95%CI）of study outcomes among patients with different blood pressures levels in acute phase were calculated by using multiple logistic model. And also multiple logistic model also was used to analyzed the influence of acute cerebral infarction antihypertensive treatment on prognosis. Kaplan-Meier method was adopted to draw cumulative events curve during follow-up of the two groups, and statistics difference was tested by Log-rank method .Result1 The blood pressure of patients with acute cerebral infarction was highest in admission and decreased rapidly in 24 hours. During 5～7 days, blood pressure was gradually steady , after the variance analysis of the average daily blood pressure of 8th to 14th days, finding that there was no statistically significant of the differences. It showed that blood pressure was basically stable from 8 to 14 days. Comparing the blood pressure of intervention group and control group at different time points, t-test result displayed that, there was no statistically significant of the blood pressure difference between two groups of patients on admission. On the 4^th,5^th,6^th,7^th,8^th～14 days,there was the obvious difference of systolic blood pressure of the two groups that intervention group was lower than those of the control group, but there was no difference in diastolic pressure of these two groups on different time points.2 By using multiple logistic regression analysis adjusted for age, sex, history of hypertension, after admission NIHSS scores, compared to those with the average SBP in 24 hours after admission of 140～159mmHg, RR of 14 days and 3 months study outcome were statistically significant for ischemic stroke patients with SBP of <119mmHg、160～179mmHg、≥180mmHg,respectively,P<0.05.Based on SBP of 140～159mmHg,risk of study outcome increased with SBP increasing or decreasing,there was a U shape relationship between average SBP in 24 hours after admission and study outcome.By using multiple logistic regression analysis adjusted for age, sex, history of hypertension, after admission NIHSS scores, compared to those with the average DBP in 24 hours after admission of 90～99mmHg, RR of 14 days and 3 months study outcome were statistically significant for ischemic stroke patients with SBP of < 79mmHg、≥110mmHg, respectively,P<0.05. On the basis DBP level of 90～99mmHg,risk of study outcome increased with DBP increasing or decreasing,there was a U shape relationship between average DBP in 24 hours after admission and study outcome.3 By using multiple logistic regression analysis adjusted for age, sex, history of hypertension, after admission NIHSS scores,comparing with<140mmHg, when the average SBP in 7 days after admission is 160～179mmHg,RR of 14 days study outcome were statistically significant, P < 0.05,but the 3 months RR were not significant. With the average SBP in 7 days after admission of≥180mmHg, 14 days,3 months risk of study outcome of patients with acute cerebral infarction would rise.By using multiple logistic regression analysis adjusted for age, sex, history of hypertension, after admission NIHSS scores, compared to those with the average DBP in 7 days after admission of <90mmHg, RR of 14 days and 3 months study outcome were statistically significant for ischemic stroke patients with SBP of≥110mmHg,P<0.05.4 There was not statistically significant in 14 days NIHSS scores and the ratio of death or life dependent of intervention group and control group. It explained that antihypertensive therapy in acute phase has no influence on 14 days prognosis of patients with cerebral infarction; In 3 months, comparing with the control group, NIHSS scores of intervention group was significantly lower,neural function had been obviously improved, and the ratio of death or life dependence was also lower.5 Apply Kaplan-Meier method to calculate the ratio of accumulate events of intervention group and control group and than draw cumulative events curve.The result of Log-rank test had show thatχ²=1.882,P=0.170, there was no statistically significant difference between intervention group and control group in 3 months accumulated events .6 Multiple logistic regression analysis found that antihypertensive therapy has no influence on 14 days death or life dependence.But antihypertensive therapy was given during the acute phase of cerebral infarction what can reduce the 3 months risk of death or life dependence. In addition, the result of Multiple logistic regression analysis show: the decline range of blood pressure in 24 hours,age,NIHSS scores on admission is related with 14 days, 3 months prognosis of acute ischemic stroke.Conclusion1 The blood pressure of patients with acute cerebral infarction was highest in admission and decreased rapidly in 24 hours. During 5～7 days, blood pressure was gradually steady and would keep at this level from 8 to 14 days.2 When the average SBP in 24 hours after admission were 140～159mmHg or average DBP in 24 hours after admission were 90～99mmHg,the incidence rate of death or life dependence in 14 days and 3 months was lowest.And the patients with acute ischemic stroke had the best prognosis. Based on SBP of 140～159mmHg or DBP of 90～99mmHg,risk of study outcome increased with blood pressure increasing or decreasing,there was a U shape relationship between average blood pressure in 24 hours after admission and study outcome. Higher SBP and DBP in 7 days after admission could increase risk of study outcome among ischemic stroke patients.3 Antihypertensive therapy in acute phase had no influence on 14 days prognosis of patients with cerebral infarction,but it could improve neural function and reduce the risk of death or life dependence at 3 month.