| PartⅠPrognostic significance of early systolic blood pressure variability after endovascular thrombectomy and intravenous thrombolysis in acute ischemic stroke:A systematic review and meta-analysisBackground:Previous studies have shown inconsistent results regarding the effect of early systolic blood pressure variability(SBPV)after endovascular thrombectomy(EVT)and intravenous thrombolysis(IVT)on functional outcome in acute ischemic stroke(AIS).The systematic review and meta-analysis aimed to determine the effect of early SBPV after EVT and IVT on outcome in AIS.This study aimed to investigate the effects of early SBPV after EVT and IVT on the prognosis of AIS by meta-analysis.Methods:We searched for articles published before February 2020 in the following databases:Pub Med,Web of Science,EMBASE,Medline and Google Scholar.The pooled multivariate odds ratios(ORs)or relative risks(RRs)and 95%confidence intervals(CIs)were obtained using STATA 13.0 software.Results:Increased early SBPV after EVT was significantly associated with worse functional outcome in AIS(OR=1.42,95%CI 1.02 to 1.99,I~2=82.4%,p value of Q test<0.001),whereas no significant associations were indicated between SBPV after IVT and functional outcome,symptomatic intracerebral hemorrhage(s ICH)in AIS[functional outcome:RR=1.08,95%CI 0.96 to 1.22,I~2=0.0%,p value of Q test=0.793;s ICH:RR=2.40,95%CI 0.71 to 8.03,I~2=78.2%,p value of Q test=0.01].Conclusions:The present study provided evidence that increased early SBPV after EVT is related to worse longer-term functional outcome in AIS,but the association is not significant in AIS patients treated with IVT.Furthermore,individualized BP management strategies were essential for AIS patients after EVT or IVT.Part Ⅱ The effects of blood pressure variability on prognosis of acute ischemic stroke with intravenous thrombolysis therapy: a case-control studyBackground: Hypertension is an important risk factor for AIS.The effect of BPV on the outcome of AIS is still inconclusive.The effects of short-and medium-term BPV after intravenous thrombolysis(IVT)therapy on clinical neurological recovery,hemorrhagic transformation and early neurological deterioration(END)provide a basis for future blood pressure management after reperfusion therapy.Methods: A retrospective analysis of patients with AIS treated with intravenous rt PA thrombolysis,collected between September 2018 and July 2021.According to the modified Rankin Scale(m RS)m RS score,patients were divided into a good prognosis group(0-1 points)and a poor prognosis group(2-6 points).Taking Mean arterial pressure(MAP),Standard Deviation(AD),Coefficient of variation(CV),Average Real Variability(ARV),residual SD(RSD)and blood pressure range(RR)as quantitative indicators of BPV.The BPV-related index data of Systolic pressure(SBP)and Diastolic pressure(DBP)at 2h,24 h,and 7d after intravenous thrombolysis were recorded,and the m RS score at 3 months after treatment was calculated.Spearman’s rank correlation coefficient and multivariable linear regression model were used to analyze the relationship between BPV and m RS score.The relationship between BPV and clinical neurological recovery,poor prognosis,hemorrhagic transformation and END were evaluated by Logistic regression model and receiver operating characteristic(ROC).Results: 1.After IVT therapy,the 2h,24 h,7d BPV(SD,CV,ARV,SV,RSD,RR)of the poor prognosis group were significantly higher than those of the good prognosis group.2.BPV was positively correlated with the m RS score at the 3rd month after treatment.After adjusting for confounding factors,24 h SBP-CV and 7d SBP-SD were independently correlated with the m RS score.3.In patients with poor collateral circulation and moderate AIS,the m RS score at 2h,24 h,7d BPV and the 3rd month after reperfusion therapy was significantly positively correlated;for patients with good collateral circulation,there was no correlation between BPV-related indicators and m RS scores.4.In multivariate logistic regression analysis,2h DBP-SD,2h DBP-RSD,24 h SBP-RR,24 h DBP-SD,24 h DBP-CV,7d SBP-CV,7d SBP-RR,7d DBP-SD,7d DBP-CV and 7d DBP-RR were Independent influencing factors of poor prognosis in clinical neurological recovery.In the ROC curve analysis results,2h,24 h SBPV(SD,CV,ARV,RSD and RR)and 7d SBP-ARV,SBP-RR have good predictive value for poor prognosis of clinical neurological recovery.5.BPV was not associated with hemorrhagic transformation.6.2h SBP-RR,24 h SBP-SD,24 h SBP-RR and 7d SBP-CV were independent influencing factors of END.Conclusions: Higher BPV is associated with poor prognosis of clinical neurological recovery and END aggravated,but has no significant effect on hemorrhagic transformation.Part Ⅲ The exploration on the relationship between cognitive impairment and blood pressure variability after intravenous thrombolysis for acute ischemic strokeBackground: Post-stroke cognitive impairment(PSCI)is a common complication of stroke.At present,the relationship between blood pressure variability(BPV)and PSCI is still inconclusive.There are few studies on the effect of BPV on PSCI in AIS patients treated with IVT.This study aimed to investigate the relationship between BPV and PSCI in stroke patients treated with IVT,and to provide evidence for early blood pressure intervention.Methods: Patients with AIS treated with IVT between September 2018 and February 2021 were prospectively enrolled.Using MAP,SD,CV,ARV,RSD and RR as quantitative indicators of BPV,the BPV-related index data of systolic and diastolic blood pressure at 2h,24 h,and 7d after IVT treatment were recorded.The Montreal cognitive assessment(Mo CA)scores on the 3rd day,3rd month and 6th month after IVT treatment were counted.Subjects were divided into PSCI group and non-PSCI group according to Mo CA score.Spearman rank correlation test and multiple linear regression analysis model were used to analyze the relationship between BPV and Mo CA score.The relationship between BPV and PSCI was evaluated by logistic regression model and ROC.Results: 1.At the 3rd month after IVT treatment,the SBP-ARV,DBP-CV and DBP-ARV of 24 h BPV,the DBP-SD,DBP-CV,DBP-ARV and DBP-RSD of 7d BPV in the PSCI group were significantly higher than those in the non-PSCI group,the differences were statistically significant(p<0.05);at the 6th month,the SBP-SD,SBP-RSD,SBP-RR of 2h BPV,the SBP-ARV、SBP-RSD、DBP-CV and DBP-ARV of 24 h BPV and the most of 7d BPV indicators related in the PSCI group were significantly higher than those of the non-PSCI group,and the differences were statistically significant(p<0.05).2.At the 3rd month after IVT treatment,the SBP-SD、SBP-ARV、SBP-RSD and the SBP-RR of 2h BPV,SBP-ARV and DBP-ARV of 24 h BPV,the most of 7d BPV indicators related were negatively correlated with Mo CA score,and after adjusting for confounders,7d DBP-CV was still independently correlated with Mo CA score;at the 6th month,the SBP-SD、SBP-RSD、SBP-RR and DBP-ARV of 2h BPV and SBP-CV、SBP-ARV、SBP-RR、DBP-CV and DBP-ARV of 24 h BPV and the most of 7d BPV indicators related were negatively correlated with Mo CA scores,2h SBP-RR、7d SBP-SD and 7d SBP-ARV remained independently associated with Mo CA scores after adjusting for confounders.3.At the 3rd month after IVT treatment,in the case of normal blood homocysteine(HCY)level,the 2h MAP was positively correlated with Mo CA score;the SBP-SD,SBP-RSD and SBP-RR of 2h BPV,the SBP-ARV、DBP-CV and DBP-ARV of 24 h BPV and the most of 7d BPV indicators related were negatively correlated with Mo CA score;In the case of high level of HCY,BPV at 2h,24 h and most of 7d had no significant correlation with Mo CA score;at the 6th month,the SBP-SD,SBP-CV,SBP-RSD,SBP-RR,DBP-SD,2h DBP-CV,DBP-ARV,DBP-RSD and DBP-RSD of 2h BPV,the DBP-CV and DBP-ARV of 24 h BPV and the most of 7d BPV indicators related were negatively correlated with Mo CA scores,while in the case of high level of HCY,only 24 h SBP-ARV and the 7d SBP of BPV were negatively correlated with Mo CA score.4.In multivariate regression analysis,the HCY level,24 h DBP-ARV and 7d SBP-CV were independent risk factors for PSCI at 3 months;the HCY level,2h SBP-SD,24 h DBP-ARV and 7d SBP-CV were independent risk factors for PSCI at 6 months,and 7dSBP-CV had a moderate predictive value for PSCI.Conclusions: The increase of BPV will significantly increase the risk of PSCI in AIS patients treated by IVT,which is more significant in patients with normal homocysteine level. |
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