| Background: Stroke is an acute cerebrovascular disease,including ischemic stroke and hemorrhagic stroke,characterized by high morbidity,high mortality,and high disability.Coronary artery disease is a kind of heart disease caused by stenosis or obstruction of vascular cavity caused by coronary atherosclerosis,which leads to myocardial ischemia.Hypertension,as an important controllable risk factor for stroke and coronary heart disease,suggests that antihypertensive therapy is particularly important for preventing the onset and recurrence of both.In recent years,more and more clinical data show that stroke and coronary heart disease often coexist at the same time,and both acute ischemic events are often associated with each other.The reasons for this are closely related to improper regulation of blood pressure.At present,whether blood pressure changes can affect the heart and brain function still needs further study and research.Objective: In this study,the dynamic electrocardiogram and blood pressure monitoring was performed in patients with acute cerebral infarction complicated with coronary heart disease.The aim was to investigate the correlation between blood pressure changes and cardio-cerebral ischemia events in this type of patients and to find a proper blood pressure range for the absence of ischemic events in the heart and brain.Methods: From March 2016 to December 2016,select 107 patients with acute cerebral infarction and coronary heart disease who met the inclusion criteria in our department of neurology and collected relevant basic data,including age,gender,body mass index,admission systolic blood pressure,and admission diastole blood pressure,fasting plasma glucose,total cholesterol,triglyceride,low density lipoprotein cholesterol,high density lipoprotein cholesterol,blood uric acid,blood homocysteine,smoking history,drinking history.According to whether or not there is history of hypertension,it is divided into hypertension group(59 cases)and non-hypertension group(48 cases)for 24 hours dynamic heart electrokinetic blood pressure monitoring.The ambulatory ECG blood pressure recorder uses the Wuxi Zhongjian CB-2302-A recording box.The recording time is from 08:00-09:00 am to 08:00-09:00 the next morning.Recording method: According to the blood pressure measurement specification,the blood pressure cuff is placed on the upper arm of the patient's healthy side,is connected to the recording box through a hose,and then the 12 lead 10 electrode sheet is placed on the position diagram,and the recording box is connected with the chest wall with a wire for 24 hours continuous record.The results are analyzed by computer playback.Parameter setting: The blood pressure setting is divided into 06:00-22:00 during the day and 22:00-06:00 during the night.The effective measurement range is systolic blood pressure 70~260 mmHg and diastolic pressure 40~150 mmHg.The pulse pressure difference is 20~50 mmHg.It is measured automatically every 30 min during the day and once every 60 min during the night.The effective number of blood pressure measurement values must reach 85 % of the number of times that should be measured.The recorded blood pressure values were divided into blood pressure subgroups according to the statistical grouping method.The upper limit of the last group segment was set to "Guide to the diagnosis and treatment of acute ischemic stroke in China in 2014".The blood pressure subgroup was divided as follows: group A: 100~120 / 70~80 mmHg,group B: 120~140 / 80~90 mmHg,group C: 140~160 / 90~100 mmHg,group D: 160~180 / 100~110 mmHg,group E: 180~200 / 110~120 mmHg.Classification of ischemic events: heart ischemia,brain ischemia,heart-brain ischemia and heart-brain without ischemia.The effective blood pressure value and the number of corresponding ischemic events were taken as the object of study.The distribution of the number of ischemic events in the hypertension group and non-hypertension group was observed in each blood pressure subgroup.Results: 1.The basic data of patients with hypertension group and non-hypertension group were compared,P>0.05,the difference was not statistically significant;2.Hypertension group,heart-brain without ischemic events are mainly distributed in SBP C,D group(?2 = 106.158,60.465,P<0.01)and DBP B,C group(?2 = 79.196,55.099,P<0.01);3.Non-hypertension group,heart-brain without ischemic events are mainly distributed in SBP B,C group(?2 = 56.090,123.131,P<0.01)and DBP B,C group(?2 = 124.196,74.130,P<0.01);4.In both groups,the incidence of heart-brain without ischemic events gradually increased with increasing blood pressure to the peak and then gradually decreased.Conclusion: 1.The change of blood pressure is related to the occurrence of cardio cerebral ischemia events in patients with acute cerebral infarction and coronary heart disease.2.In the hypertension group,the blood pressure control was in the range of 140~180 / 80~100 mmHg,which significantly reduced the incidence of heart-brain ischemia.3.In the non-hypertension group,the blood pressure remained within the range of 120~160 / 80~100 mmHg,resulting in a relatively small chance of heart and brain damage.4.In both groups,the incidence of heart-brain without ischemia was "inverted U-shaped" as the blood pressure gradually increased,suggesting that the blood pressure could not be too low or too high and should be controlled as far as possible within a safe range. |
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