Correlation Between H-type Hypertension And Vascular Stenosis In Patients With Ischemic Stroke

Background and Purpose:Cerebrovascular disease is common and frequent occurring in Neurology,referring to brain dysfunction caused by cerebrovascular disease. At present, it isone of the three major diseases that cause human death. According to the durationof neurologic deficits or pathological nature, it can be divided into ischemiccerebrovascular disease such as cerebral infarction, hemorrhagic cerebrovasculardisease such as intracerebral hemorrhage, vascular dementia, cerebral amyloidangiopathy etc. And the most common clinical disease is ischemic stroke. It isusually acute onset, more common in middle and elderly patients, manifested asrestricted movement of limbs, speech disfluency and disturbance of consciousness.Our country is a high incidence of cerebrovascular disease, about50%-70%ofpatients with cerebrovascular disease will be left with severe sequelae of disability,limiting the daily life of the normal behavior, and it is a burden to the family andcountry.At present, the cause of ischemic stroke is numerous; the effect of H-typehypertension on ischemic stroke is attracting more attention. H type hypertensionis hypertension accompanied by elevated homocysteine. In our country, manypatients with hypertension group had elevated homocysteine. Current studieshave shown that hypertension and homocysteine are closely related to theoccurrence of arterial stenosis, which are two independent risk factors for theoccurrence and development of ischemic stroke. But the study about thecorrelation between H type hypertension and the severity of vascular stenosis inpatients with ischemic stroke is relatively scarce. This study mainly focused onthe design and analysis for the relationship, in order to provide new ideas and methods for the clinical diagnosis and treatment.Methods：1.365patients from March2009to March2013with ischemic strokeaccompanied by vascular stenosis admitted to neurology department of the FirstAffiliated Hospital of Zhengzhou University were selected. There are212males,153females; mean age is (60.7±11.2) years old. After brain imaging confirmed,they were accorded with the Fourth Academic Meeting of our country on therevised diagnostic criteria of cerebrovascular disease, and the presence of vascularstenosis by brain CTA examination after admission. Ischemic stroke can bedivided into five types according to the International TOAST etiology type, thestudy of patients with ischemic stroke was only caused by atherosclerosis. Andpatients of taking folic acid or vitamin B, immunosuppressive agents or antiepileptic drugs within2weeks, and liver and kidney dysfunction were excluded.Records of each patient’s demographic characteristics, behavioral risk factors, andclinical and biochemical indicators were detailed noted.2. Fasting collection of3ml of elbow venous blood of all the patients wereadmitted to the hospital at the next morning. After centrifugation serum, usingAXSYMTM immune luminescence detector produced by American companyAbbott, levels of plasma homocysteine was determined within half an hour.3. Using the dual-source speed128-slice CT produced by the German Siemenscompany, and2or more clinical workers trained by unified proceduresindependently analyzed cranial CTA angiography results. According to themethod of the North American Symptomatic Carotid Endarterectomy Trialanalyze the degree of stenosis of the research vessel. In this study, we performedthe following definition: the degree of vascular stenosis is less than50%for mildstenosis; between50%-70%for moderate stenosis; more than70%for severestenosis (including vascular occlusion).4. The brachial artery in Cubital fossa place was measured by using standardmercury sphygmomanometer. With the interval of1~2min after repeatedmeasurement, taking the average of two, and calculating not only systolic blood pressure but also diastolic blood pressure. According to the2004ChineseHypertension Prevention Guide diagnostic criteria, the high blood pressure levelswere divided into normal (including high-normal blood pressure and normalvalue), hypertension grade1, hypertension grade2, and hypertension grade3.When the diastolic and systolic blood pressure levels are not the same, the finalhypertension will be the highest level.5. Using SPSS17statistical software. Due to hypertension grade and thedegree of vascular stenosis are ordered classification data, using a χ2test in orderto clear whether there is difference between different levels of hypertension andthe degree of vascular stenosis, then the two-variable correlation was analyzed.The relationship between homocysteine and the degree of vascular stenosis useone-way analysis of variance, and then Sperman correlation was analyzed. For therelationship between H-type hypertension and vascular stenosis in patients withischemic stroke, using a χ2test first in order to clear whether there is differencebetween each group and the degree of vascular stenosis; In the logistic regressionanalysis, respectively, the degree of vascular stenosis is as the dependent variable,and the variety of possible risk factors of vascular stenosis in ischemic stroke is asindependent variable, were carrying on a regression model; The relationship ofhypertension and hyperhomocysteine on the degree of vascular stenosis in patientswith ischemic stroke was performed by interaction analysis. The relationshipbetween H-type hypertension and the sites of vascular stenosis was performed aχ2test. The difference was statistically significant（P＜0.05).Results：1. There is difference between different levels of hypertension and the degreeof vascular stenosis（P＜0.05). Hypertension is associated with the degree ofvascular stenosis in patients with ischemic stroke, the difference is statisticallysignificant（r=0.498, p<0.05).2. Compared between the degree of vascular stenosis in patients with ischemicstroke, the difference of homocysteinemia is statistically significant（P＜0.05).Meanwhile, the difference is also found in further multiple comparisons betweengroups,（P＜0.05). 3. Neither hypertension nor high homocysteine, none hypertension but withhigh homocysteine, none high homocysteine but with hypertension, hypertensionaccompanied by high homocysteine, the differences between the degree ofvascular stenosis of the above four groups are statistically significant（p<0.05).And further studies shows that there is a existence of positive additive interactionbetween hypertension and hyperhomocysteinemia(S=1.83＞1).4. The degree of vascular stenosis is as the dependent variable, and thepossible risk factors of vascular stenosis in ischemic stroke is as independentvariable, were carrying on the multi-factor logistic regression analysis, it showsLDL (OR=2.589, P=0.024), hypertension (OR=4.482, P=0.026), diabetes (OR=3.342, P=0.047), H CY (OR=1.544, P=0.001). In the vascular stenosis, theserisk factors are independent.5. H-type hypertension and the sites of vascular stenosis have no correlation（P＞0.05）.Conclusions：1. Logistic regression analysis shows that hypertension, homocysteine, LDL,diabetes are all independent risk factors to vascular stenosis.2. Hypertension and high homocysteine have synergistic effect.3. H-type hypertension and the position of vascular stenosis in patients withischemic stroke have no correlation.