Study On The Characteristic And Influence Factors Of The Blood Pressure Variability In Acute Patients With Hypertensive Cerebral Hemorrhage

Objective To investigate the relationship between the first systolic blood pressure with the blood pressure variability(BPV) within the first three days after being hospitalized,and provide clinical evidence for optimal management of blood pressure in patients with hypertensive cerebral hemorrhage(HCH);To explore the differences and change characteristics of long time BPV and short time BPV of the surgical and non-surgical patients with HCH in the first 7 days after admission; To study the correlative factors of BPV in patients with HCH in acute stage. Methods 264 patients with HCH was included from November 2013 to July 2015,All patient’s first blood pressure(BP) after being hospitalized was the initially BP, then,patients’ BP was measured by ambulatory blood pressure monitoring(ABPM) per hours in the first 7 days, we divided those patients into different groups according to the following three methods.(1)The non-surgical patients was divided into three groups according to the initially systolic blood pressure(SBP),group A the SBP was less than 140 mm Hg,group B the SBP was 140~179mm Hg,group C was 180 mm Hg or more than 180 mm Hg,then we used the standard deviation(SD), coefficient of variation(CV) and weighted standard deviation(WSD) as indexes to evaluate the difference of systolic blood pressure variability(SBPV) between the three groups in third days after admission;(2) All patients was divided into surgery group(S group) and non-surgery group(NS group) according to they whether had stereotactic minimally invasive puncture drainage surgery,Then we used the SD,CV,WSD,average real variability(ARV) and average successive variability(ASV) as the evaluation index of BPV to evaluate the differences and change characteristics of short time SBPV and long time SBPV between the two groups in 7 days after admission;(3) 264 patients were divided into two groups according to the critical value of the first day’s systolic blood pressure standard deviation after being hospitalized which was diagnosed by receiver operating characteristic curve(ROC curve),then analyzed the differences of some factors such as initially SBP, mean SBP of the first day,intracranial hematomas, the National Institutes of Health Stroke Scale(NIHSS score),total cholesterol and triglyceride between with the two groups,there more, we still analyzed the correlation between those factors with the SBP SD at the first day after on admission. Results(1) 182 non-surgery patients was included,117 was male,65 was female,age 35~94 years old,the average age 61.3±13.7 years old,the intracranial hematomas 2~60(17.2±10.6)ml, the NIHSS score 0~25(9.3±6.8)score,the initially SBP 106~238(163.0±25.1)mm Hg, initially diastolic blood pressure(DBP)50~155(96.0±18.0)mm Hg, The patients’ SBP SD,CV,WSD in group C at the first day was significantly high than that in group A and group B(p<0.05),the patients’ SBP SD,CV,WSD in group A and group B had no significant difference(p>0.05),the patients’ SBP SD and rang in group C at the second days was significantly high than that in group A and group B(p<0.05),but the SBP CV and w SD had no significant difference between with the three groups(p>0.05),the patients’ SBP SD,CV and WSD at the third days after admission was not statistically significant(p>0.05).(2) 264 patients was included,age 35~94 years old,the average age 61.3±13.7 years old,82 patients was included in group S,those patients average age 58.0±13.8 years old,48 patients was male,34 patients was female,the initially SBP was 88~235(167.5±31.2)mm Hg,initially DBP was 60~152(97.7±20.2)mm Hg, The SBP SD of the first day after being hospitalized was 3.3~29.7(15.3±5.0)mm Hg;182 patients was included in group NS,those patients’ SBP SD of the first day after being hospitalized was 4.7~40.7(12.8±5.1)mm Hg.The intracranial hematomas, NIHSS score and initially SBP in group S was significantly high than that in group NS(p<0.05),The patients’ SBP SD, CV, w SD, ARV and ASV of every days in the 7 days after being hospitalized in group S was significantly high than that in group NS(p<0.05),the long time SBPV in 7 days between the two groups had statistical difference(p<0.05),which in the group S was significantly high than which in group NS.(3)The initially SBP, mean SBP of the first day,intracranial hematomas,NIHSS score,total cholesterol, triglyceride, apolipoprotein a and serum creatinine in BPV increased group was significant high than that in BPV decreased group(p<0.05),but there was no significant difference in age, sex, smoking, drinking, and so on(p>0.05).The correlation between the SBP SD with the initially SBP(r=0.326;p=0.000),the NIHSS score(r=0.221;p=0.004),the intracranial hematomas(r=0.221;p=0.004),the apolipoprotein b(r=0.203;p=0.008),the creatinine(r=0.199;p=0.009),the total cholesterol(r=0.171;p=0.025),the BMI( r=0.163;p=0.033) and the triglyceride( r=0.163;p=0.033) was significant. Conclusion(1)The BPV of the patients with HCH in the first two days after admission were affected by the initially SBP.(2)The patients with HCH who underwent surgical treatment for 7 days after admission,whose the long time BPV and short time BPV were increased.(3)BPV and the blood pressure level, blood lipid level,the amount of intracranial hemorrhage,the degree of neurological deficits and body mass index were positively correlated. In the management of blood pressure in the acute phase of patients with HCH, we should pay more attention on the effects of the initially SBP,the mean SBP of first day,the intracranial hematomas,the NIHSS score,the total cholesterol,the triglyceride,the apolipoprotein a,the serum creatinine and the surgical treatment.(4) The prognosis of patients with HCH may be worse in those whose BPV increased.