| Background: Endovascular treatment(EVT)is advocated as a safe and effective novel treatment for acute ischemic stroke(AIS)with large-vessel occlusion(LVO).After successful endovascular treatment,there is still disagreement about the range of blood pressure values to be controlled.Blood pressure variability(BPV)is also an important factor for the outcome of LVO-AIS patients.The aim of this study was to investigate whether the effect of systolic blood pressure variability on the prognosis of AIS-LVO patients with successful recanalization after EVT was affected by the use of antihypertensive drugs.Methods: We retrospectively enrolled consecutive AIS-LVO patients with successful recanalization after EVT at the Department of Neurology,General Hospital of Northern Theater Command between May 2018 and December 2021.The patients were categorized into two groups according to the use of antihypertensive drugs(Yes=136,No=78).Functional independence at 3 months was defined as a modified Rankin Scale(m RS)score of 0–2.We collected demographics,cerebrovascular disease related history,clinical features,imaging features,and EVT features.Hourly systolic blood pressures(SBP)were recorded in the first 24 h post-EVT.The other SBP parameters including SBP max,SBP min were also recorded.We calculated the BPV of systolic blood pressure in the first 24 hours after EVT in all patients and in different groups using eight methods.Logistic regression analysis was performed to assess the prediction of BPV on prognosis,and two prediction models were constructed(model 1: adjusted for diabetes,admission NIHSS,m TICI,onset to reperfusion time,use of antihypertensive medication,and cerebral hemorrhage;model 2: adjusted for diabetes,admission NIHSS,m TICI,onset to reperfusion time,and cerebral hemorrhage),and parallel subject work characteristics(ROC)curve analysis to assess whether the use of antihypertensive medication affects the predictive ability of SBP variability on prognosis.Results: In this study,320 AIS-LVO patients were enrolled,and 214 cases were finally included in the current analysis after excluding 106 patients.Of 214 patients,92(43.0%)had a good prognosis,of which 43(46.7%)used antihypertensive drugs,and 122(57.0%)had a poor prognosis,of which 93(76.2%)used antihypertensive drugs,which was statistically significant in both groups(p <0.001).BPV was significantly lower in good outcome group than t poor outcome group.In the logistic analysis of both models in the overall population,Δ1,SD,CV,SV,ARV,ACACP,and MCAPC were significantly associated with poor prognosis after EVT in AIS-LVO.Receiver operating characteristic(ROC)curves showed that the area under the curve(AUC)was significantly larger in model 1 than in model 2(ΔAUC,0.031-0.040,P<0.05),and model 1 had better predictive power(AUC,0.774-0.783,P<0.05).In logistic regression analysis,when the relationship between systolic blood pressure variability and prognosis was examined using the use of antihypertensive medication as a subgroup,we found that systolic blood pressure variability in the no antihypertensive medication group consistently predicted adverse outcomes except for median continuous absolute percentage change(MCACP)(dominance ratio,1.078-1.427,P < 0.05),and in multivariate adjusted for admission NIHSS,ICH model,systolic blood pressure variability measured by the seven methods remained significantly associated with adverse outcomes(dominance ratio,1.083-1.421).In models adjusted for baseline ASPECT,m TICI,admission NIHSS,and time from onset to reperfusion,the dominance ratios for adverse outcomes for systolic blood pressure variability ranged from 1.096 to1.450(all P < 0.05).However,all indicators of systolic blood pressure variability in the group using antihypertensive drugs were not associated with poor prognosis(P > 0.05).Conclusion: In AIS-LVO patients with successful recanalization after EVT,the use of antihypertensive drugs can somewhat influence the prediction of systolic blood pressure variability on prognosis. |
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