The Correlation Study Between Blood Pressure Variability And Ischemic Cerebral White Matter Lesions

Objective:1 To analyze the relationship between blood pressure variability and ischemic white matter lesions.2 To analyze the common risk factors of ischemic white matter lesions.3 To observe the progress of ischemic white matter through rational control of blood pressure after two years.Methods:From May 2014 to December 2016,a total of 91 patients with ischemic white matter lesions combined hypertension,who were admitted to the Second Affiliated Hospital of Hebei Medical University,Department of Neurology were enrolled in the study,Including 38 males and 53 females.Recorded the basic clinical datum of all the patients,including age,gender,height,weight,education years,previous medical history of antiplatelet drugs,previous history of diabetes,coronary heart disease,hyperlipidemia,stroke,smoking history,drinking History,biochemical information,electrocardiogram,carotid artery ultrasound,imaging datum(including MRI+MRA+DWI+SWI),the result of 24 h ambulatory blood pressure monitoring(ABPM)and so on.The patients would be followed by telephone calls or outpatient services,at the first month,the third month,and the twelfth month,consulting the condition of anti-hypertension drug taking,the control level of blood pressure and the recurrence of stoke.If the control level of blood pressure was not ideal,guide the adjustment of anti-hypertension drug,to stable blood pressure level at130-140/80-90 mmHg.At the end of two-year follow-up,electrocardiogram,carotid artery ultrasound,Transcranial Doppler ultrasonography,Imaging datum(including MRI+MRA+DWI+SWI),24 h ambulatory blood pressure monitoring(ABPM)were examined.According to the MRI and Fazekas scale91 patients were divided into absent/mild WML group and moderate/severeWML group.To analyze the relationship between hypertension,blood pressure variability,circadian rhythm of blood pressure and ischemic white matter lesions,to explore the risk factors of ischemic white matter lesions by Logistic regression analysis,and to investigate the effects of different antihypertensive drugs(calcium antagonists and angiotensin converting enzyme inhibitors)and the control level of blood pressure on white matter lesions in two years.Results:1 A total of 91 patients were divided into two groups,there were 57 cases of absent/mild WML group(23 males,average age 61.78 ± 7.59 years)and 34 cases of moderate/severe WML group(15 males,average age 64.88 ± 7.21years).The age,high homocysteinemia in the moderate/severe WML group was statistically significant compared with the absent/mild WML group(P<0.05),but other clinical data(gender,hyperlipidemia,coronary heart disease history,history of diabetes,smoking history,drinking history,etc.)were not statistically significant(P> 0.05).2 Comparison of 24 h dynamic blood pressure parameters between the two groups: compared with the absent/mild WML group,The 24hSBP-CV and24 hSBP in the moderate/severe WML group were significantly higher(P<0.05).There was no significant difference between the two groups in terms of 24 hDBP,DSBP,DDBP,NSBP,NDBP and 24hDBP-CV(P> 0.05).3 There were 15 cases of diarrhea blood pressure circadian rhythm in the absent/mild WML group and 3 cases in the moderate/severe WML group,the difference were statistically significant,using chi-square test(?2 = 4.107,P =0.043).4 Analysis of the risk factors of WML:Multivariate logistic regression analysisExplored the risk factors of WML by multivariate logistic regression analysis.The results showed that: the age(OR = 13.563),Hyperhomocysteinemia(OR = 1.096),24hSBP(OR = 4.445),24hSBP-CV(OR = 4.695)and non-dipper blood pressure(OR = 1.076)entered theregression equation,The difference was statistically significant(P <0.05).5 A total of 15 cases had completed two years follow-up.Considering the number of follow-up cases is too small,if to explore the effect of different antihypertensive drugs(calcium antagonists and angiotensin converting enzyme inhibitors)and the control level of blood pressure on white matter lesions,greater biases might occur.So we should make a deeper comparison study until all patients had been followed up.Conclusion:1 Age,hypertension,homocysteine are independent risk factors for WML.For high risk patients,it is helpful to detect and prevent WML by screening these risk factors.2 Blood pressure variability,especially the fluctuates and rises of 24-hour systolic blood pressure,is closely related to the occurrence and progress of WML.3 The disappearance of normal diarrhea blood pressure rhythm and the existence of WML is positively related.