| Background:Cerebral infarction(CI)is the main cause of death and disability in adults in China,accounting for approximately 85% of the total number of strokes.With the aging population and continuous social development,the risk of CI continues to rise.There are research reports that after the age of 55,the risk of CI more than doubles every ten years.The recurrence rate of CI is extremely high.Repeated stroke attacks not only significantly increase cognitive risk,but also double the risk of death,placing a heavy burden on individuals,families,and society.Therefore,effective preventive measures are crucial for patients with CI.Hypertension is the most important controllable risk factor for CI.PROGRESS study suggests that antihypertensive therapy can reduce the risk of stroke recurrence in stroke patients.However,the target level for blood pressure reduction is still controversial.Objective: 1.To explore whether intensive anti-hypertensive therapy can reduce the risk of stroke recurrence in elderly patients with CI.2.To explore the effect of intensive anti-hypertensive therapy on cognitive function in elderly patients with CI.3.To explore whether intensive anti-hypertensive therapy can increase the risk of hypotension-related adverse events in elderly patients with CI.Methods:1.Collect patients who were diagnosed as having both hypertension and ischemic stroke during the period from October 2020 to October 2021 at Xi’an Central Hospital.Subjects who met the inclusion criteria were included and randomly assigned to three different blood pressure management groups.2.Treatment methods: the control group did not interfere with the previous blood pressure treatment,the standard anti-hypertensive group was given standard anti-hypertensive therapy(target BP<140/90 mm Hg),and the intensive antihypertensive group was given intensive anti-hypertensive therapy(target BP<130/80 mm Hg).Blood pressure was recorded during follow-up.3.Follow-up and data collection: Demographic and general data were collected at baseline.Follow up was conducted at 3 months,half a year,and 1 year after enrollment to collect biochemical indicators,MMSE scale,Mo CA scale,HIS scale,CDR scale,ADL scale,and cranial magnetic resonance imaging results.The occurrence of endpoint events(including recurrent stroke events,mild cognitive impairment,or dementia)and adverse events(including death from various causes,acute cardiac insufficiency,acute renal insufficiency,electrolyte disorders,gastrointestinal bleeding,and hypotension events)within one year were recorded.4.Statistical analysis: IBM SPSSStatistic26.0 and Med Calc20.20 statistical analysis software were used for statistical analysis,and one-way ANOVA,Chisquare test,rank sum test and survival analysis were used to compare the population and groups.The difference was statistically significant with P<0.05.Results:1.Comparison of baseline data:At baseline,there were no significant differences in age,sex,BMI,smoking history,diabetes,coronary heart disease,drug use,admission MMSE score,Mo CA score,systolic blood pressure,diastolic blood pressure,Glu,Scr,GFR,TC,TG,LDL,HDL and Hcy levels among the three groups(P>0.05).2.Blood pressure control during follow-up:At the second month after enrollment,the systolic and diastolic blood pressure of the three groups of subjects had reached the expected blood pressure setting goals.Since then,the blood pressure has remained within the expected range.The overall and inter group differences in systolic blood pressure among each group of subjects were statistically significant(H=100.55,P<0.05).The overall difference in diastolic blood pressure among subjects is statistically significant(H=43.33,P<0.01),there was no statistically significant difference between the control group and the standard anti-hypertensive group,while the differences between the other groups were statistically significant(P<0.01).3.Comparison of stroke recurrence after treatment:After anti-hypertensive treatment,compared to the control group,the standard anti-hypertensive group(14.74%,HR=0.76,95% CI 0.28-2.07)and the intensive anti-hypertensive group(6.34%,HR=0.32,95% CI0.12-0.85)showed a reduced 1-year stroke recurrence rate and cumulative risk of recurrence.Compare the recurrence of stroke after treatment: There was a statistically significant difference in the cumulative risk of stroke recurrence between the control group and the intensive anti-hypertensive group(P<0.05),while there was no statistically significant difference in the cumulative risk of stroke recurrence between the control group and the standard anti-hypertensive group,the standard anti-hypertensive group and the intensive anti-hypertensive group(P>0.05).4.Comparison of cognitive function after treatment:Compared with baseline data,after anti-hypertensive treatment,the MMSE score and Mo CA score in the control group decreased significantly;The MMSE score in the standard anti-hypertensive group did not significantly decrease,while the Mo CA score significantly decreased;There was no significant decrease in MMSE scores and Mo CA scores in the intensive anti-hypertensive group.Compare the results of the cognitive scale before and after treatment: There were no statistically significant differences in MMSE scores and Mo CA scores among the three groups before treatment(P>0.05).In addition,there were no statistically significant differences in MMSE scores and Mo CA scores among the three groups after treatment(P>0.05).Intragroup comparison showed that there was a statistically significant difference between the MMSE scores and Mo CA scores before and after treatment in the control group(P<0.01);There was no statistically significant difference between the MMSE scores before and after treatment in the standard anti-hypertensive group(P>0.05),while there was a statistically significant difference between the Mo CA scores(P<0.01);There was no significant difference in MMSE and Mo CA scores between pretreatment and post treatment in the intensive anti-hypertensive group(P>0.05).Compared to the control group,the incidence and cumulative risk of MCI were reduced in both the standard(4.90%,HR=0.49,95%CI 0.11-2.30)and intensive anti-hypertensive(1.59%,HR=0.15,95%CI0.03-0.70)groups.Compare the occurrence of MCI after treatment: There was no statistically significant difference in the cumulative risk of MCI between the control group and the standard anti-hypertensive group,and there was no statistically significant difference in the cumulative risk of MCI between the standard anti-hypertensive group and the intensive anti-hypertensive group(P>0.05).5.Comparison of adverse events after treatment:There was no significant difference in the incidence of acute renal insufficiency,acute cardiac insufficiency,hypotension,electrolyte disturbance and gastrointestinal bleeding among the three groups(P> 0.05).Conclusion: 1.Intensive anti-hypertensive therapy(BP<130/80 mm Hg)can reduce the risk of stroke recurrence in elderly patients with cerebral infarction;2.Intensive anti-hypertensive therapy(BP<130/80 mm Hg)can reduce the risk of cognitive decline in elderly patients with cerebral infarction;3.Intensive anti-hypertensive therapy(BP<130/80 mm Hg)did not increase the risk of adverse events related to anti-hypertensive therapy in elderly patients with cerebral infarction within one year. |
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