The Association Between Blood Pressure Variability During The Acute Phase Of Ischemic Stroke And Early Neurological Deterioration

Objective: we aimed to elucidate the association between blood pressure variability during the acute phase of ischemic stroke and early neurological deterioration and provide clinical evidence for blood pressure management.Methods: We prospectively studied 342 patients in department of neurology from january 1,2016 to December 31,2016 admitted with acute ischemic stroke.All of patients should be admitted during the 24 hours after the onset of stoke symptom.Caculating the difference of NHISS at discharge and NHISS score at admission,We divided these patients into the deteriorative group(DG)and the the nondeteriorative Group(NDG).The DG was defined as an increase of two or more scores in NHISS score at discharge.The NDG was defined as an increase of less than 2 scores in NHISS score at discharge.At admission,demographic data(age,sex),hypertension,type 2 diabetes mellitus,atrial fibrillation,smoking,drinking,family history of premature cardiovascular disease,history of concomitant cardiovascular disease(coronary heart disease,previous ischemic stroke),thrombolysis,symptomatic steno-occulion were recorded.The severity of stroke was assessed at admission and at discharge with the National Institutes of Health Stroke Scale(NIHSS).Routine laboratory investigations were performed after overnight fasting on the first day after admission and included serum levels of glucose,high-density lipoprotein,triglycerides,low-density lipoprotein cholesterol levels.Caculate the blood pressure during the fist three days.Variability in BP during the acute phase of ischemic stroke was assessed with the SD and with the coefficient of variation(defined as SD/mean)of SBP and DBP measurements during the first 3 days of hospitalization.In univariate analysis,variables such as general condition,laboratory indexes were compared between the two groups.Multiple logistic regression analysis was applied to investigate independent associations between BP parameters and END.To determine the possible contribution factors for DG,multivariate logistic regression analysis were done using variables with P values<0.05 in univariate analysis.Results:1.In our study,we selected 342 patients together,there were 41 patients in DG and301 patients in NDG.2.Related factors analysis:(1)DG compared with NDG,there were statistical difference in age,hypertension,type 2 diabetes mellitus,smoking,previous ischemic stroke,thrombolysis,symptomatic steno-occulion,SD of SBP,CV of SBP,NHISS score at admission(P<0.05).(2)There were no statistical difference in sex,Atrial fibrillation,Drinking,Family history of premature cardiovascular disease,Coronary heart disease,serum levels of glucose,high-density lipoprotein,triglycerides,low-density lipoprotein cholesterol levels,blood pressure at admission,SD of DBP,CV of DBP(P>0.05).3.Multivariate logistic regression analysis:(1)Multivariate logistic regression analysis showed that from the first quintiles to the fifth quintiles of SD of SBP,and CV of SBP,odds ratio for END is increasing.SBPV were independent risk factors of END(P<0.05).(2)It aslo shouws the NHISS score at admission(OR 1.241,95%CI 1.022-1.508),age(OR 1.070,95%CI 1.00-1.145)and type 2 diabetes mellitus(OR 2.116,95%CI1.457-4.418)were independent risk factors of END(P<0.05).Conclusion:1.Our study concluded that there was an association between blood pressurevariability during the acute phase of ischemic Stroke and END.2.the NHISS score at admission,age,CV of SBP,SD of SBP,symptomatic steno-occlusion,and type 2 diabetes mellitus were independent risk factors of EDG.