Analysis Of Risk Factors For The Patients With Acute Cerebral Ischemic Stroke And The Difference Impaction Among Antihypertensive Drugs On Blood Pressure Variability

?Objective?To investigate the risk factors for the patients with acute cerebral ischemic stroke,and to further explore the impaction among antihypertensive drugs on blood pressure variability.?Method?This is a retrospective cohort analysis of study 210 inpatients with acute cerebral ischemic stroke,from July 2012 to July 2014,which meet the inclusion and exclusion criteria.The basic information?medical history(including hypertension?diabetes mellitus and so on)?personal history?biochemical criterion?antihypertensive drugs intervention?the volume and the location of patients' cerebral infarction lesions?pulmonary infection?carotid inteima-media thickness and plaque formation and some other factors were collected.When patients was enrolled in hospital,we scored them for National Institutes of Health Stroke Scale(NIHSS)and measured their blood pressure(including systolic blood pressure and diastolic blood pressure)within one hour,and then monitoring blood pressure everyday.Blood pressure variability indicated days variability and was quantified by calculating the standard deviation(SD)?coefficient of variation(CV)and standard deviation independent of mean of blood pressure(SDIM),was also calculated.To understand the rehabilitation condition patients who were discharged,we called these patients after they was attacked stroke 3 months,and they would be measured by the modified Rankin Score(m RS).If some patients' m RS is lower than 3,we defined them as favorable prognosis,there else as poor prognosis.Chi-square test?t-test and multivariate logistic regression analysis were performed.?Result?Single factor analysis shows history of stroke?years?dehydrating agent?pulmonary infection?the volume of patients' cerebral infarction lesions?fasting bloodglucose?D-dimer level?Types of blood pressure medication?C-reactive protein?hypersensitive C-reactive protein ? SBP-max ? SBP-SD ? SBP-CV ? SBP-SDIM ?DBP-max?DBP-SD?DBP-CV and DBP-SDIM were significantly different between favorable prognosis group and poor prognosis group(P<0.05).After adjustment for potential confounding factors,multiple regression analysis shows NIHSS(OR=1.385,P=0.022)?DBP-max(OR=1.397,P=0.035)?SBP-SDIM(OR=15.6,P=0.012)?smoking history(OR=22.173,P=0.041)?coronary heart disease(OR=0.002,P=0.018)are related to the acute cerebral ischemic stroke patients with poor prognosis,but not to SBP-mean and DBP-mean.SBP-SDIM in Calcium channel blocker group after treatment were decreased than before treatment(P<0.05),with SBP-SDIM increasing in diuretic group,however the differences were not statistically significant in beta-adrenoceptor antagonist group and angiotensin converting anzyme inhibitior(ACEI)/ angiotensin ?(AT)receptor antagonist(ARB)group.?Conclusion? 1.SBP-SDIM and DBP-SDIM is a quantitative index of blood pressure,which is independent of blood pressure mean.2.History of stroke?years?dehydrating agent?pulmonary infection?the volume of patients' cerebral infarction lesions?fasting blood glucose?D-dimer level?Types of blood pressure medication?C-reactive protein?hypersensitive C-reactive protein?SBP-max?SBP-SD?SBP-CV?SBP-SDIM?DBP-max?DBP-SD?DBP-CV and DBP-SDIM are the possible risk factors for the acute cerebral ischemic stroke patients with poor prognosis.3.NIHSS?DBP-max?SBP-SDIM?smoking history and coronary heart disease are independently related to the acute cerebral ischemic stroke patients with poor prognosis.4.Calcium channel blocker decreases the blood pressure variability of the acute cerebral ischemic stroke patients,with diuretic increasing blood pressure variability,however there is not any impaction among beta-adrenoceptor antagonist and ACEI/ARB drugson blood pressure variability,therefore,the use of Calcium channel blocker is good for the acute cerebral ischemic stroke patients.