The Relationship Between The Level Of Blood Pressure Control And Outcomes In Patients With Acute Aortic Dissection

Objective To observe the relationship between the level of blood pressure control within 72 hours after admission and outcomes in patients with acute aortic dissection(AAD)Methods The clinical data of 307 patients with acute aortic dissection admitted to our hospital from January 2011 to June 2018 were retrospectively analyzed,including 100 patients with Stanford A-type dissection and 207 patients with Stanford B-type dissection First,the risk factors related to in-hospital death were analyzed according to the survival Second,the average systolic blood pressure recorded at six time points(Oh,6h,12h,24h,48h,72h)within 72 hours after admission was divided into four groups:Group<120mmhg(84 cases),group 120-130mmhg(93 cases),group 130-140mmhg(87 cases),group>140mmHg(43 cases).The demographics,history and the clinical presentation,examination data(laboratory and imaging),treatment and outcome of patients were recorded respectively to observe the relationship between different systolic blood pressure control levels and serious hospital complicationsResults There were significant differences in diagnosis,treatment,hospital complications,red blood cell count,platelet count,D-dimer and lactate value between the death group and the survival group(p<0.05).There was no significant difference in age,gender,BMI,onset time,related clinical manifestations(chest pain,abdominal pain,back pain,peripheral vascular syndrome),history of hypertension and Mar fan' s syndrome(p>0.05).According to the average systolic blood pressure at six time points within 72 hours after admission,the proportion of patients with type A aortic dissection and Mar fan's syndrome was the highest in the group of<120mmHg,and the proportion of patients receiving simple medication was higher than other groups,the difference was statistically significant(p<0.05).In the group of>140 mmHg,the proportion of male,BMI index(overweight)and patients with hypertension history was higher,the difference was statistically significant(p<0.05);there was no significant difference in age and clinical presentation among the four groups(p>0.05).The mortality of<120mmHg group(32%)was significantly higher than 120-130mmHg group(9%)and 130-140mmHg group(6%),the difference between the two groups was statistically significant(P<0.05),however,there was no significant difference compared with the mortality of>140mmHg group(19%).Multivariate logistic analysis showed that the mean systolic blood pressure control level of<120mmhg within 72 hours after admission,diagnosis of Stanford type A dissection,elevation of D-dimer level,pericardial tamponade,and drug therapy alone were independent risk factors for hospital death in patients with acute aortic dissectionConclusion This study found that with the increase of mean systolic blood pressure within 72 hours after admission,the hospital mortality showed a J-curve relationship with patients with AAD.After adjusting the confounding factors,the mean systolic blood pressure control level of<120mmHg were still independent risk factors for hospital death.