| Objective:The purpose of this study was to explore the relationship between blood pressure variability(BPV)in acute stage of ischemic stroke and 3-month prognosis in patients with internal carotid artery occlusion(ICAO),and to provide a scheme for blood pressure management in acute phase of ischemic stroke.Methods:From June 2017 to December 2018,patients with internal carotid artery occlusion who were admitted to the Department of Neurology,Xian yang Hospital of Yan an University were measured blood pressure at least 10 times within 48 hours after stroke.A total of 206 patients participated in the study,of which 8 met the exclusion criteria and20 were lost during follow-up.First of all,the clinical characteristics of 178 eligible patients were collected and recorded,and the blood pressure was described by several blood pressure parameters: the average of recordings,minimum,maximum,difference between maximum and minimum,standard deviation(SD)and coefficient of variation(CV).According to the dichotomous method of baseline severity,all patients were divided into good prognosis group and poor prognosis group.T test of independent samples,multivariate adjustment model and multivariate non-adjustment model were used.Including the National Institutes of Health Stroke scale(NIHSS)score as covariate,three months modified Rankin scale(mRS)score was used as a correction model of binary variables to analyze the blood pressure parameters of the two groups.After excluding the confounding factors such as age and sex,the variation parameters of blood pressure were arranged from low to high,and were divided into two groups: the smallerBPV group and the larger BPV group.The general characteristics,blood pressure parameters,mRS score and prognosis of the two groups were compared.Results:1.At 3 months,110 patients had good prognosis and 68 patients had poor pr ognosis according to the dichotomous method of baseline severity.The general ch aracteristics and blood pressure parameters of the two groups were compared as f ollows:(1)There were no statistical difference in age,male,the side of internal caroti d artery occlusion,entry NIHSS score,hypertension,diabetes,dyslipidemia,smoking between good prognosis group and poor prognosis group.Three-month NIHSS scor e of poor prognosis was significantly higher than good prognosis group.(2)The blood pressure parameters of the two groups were 48 hours after admission:the maximum value of systolic blood pressure in the poor prognosis group,the maximum value of diastolic blood pressure,the difference between the maximum and minimum systolic blood pressure,the difference between the maximum and minimum diastolic blood pressure,the standard deviation of systolic blood pressure,the standard deviation of diastolic blood pressure,the coefficient of variation of systolic blood pressure,and the coefficient of variation of diastolic blood pressure were significantly higher than those with good prognosis.(3)Our independent sample t test and multivariate non-adjustment model showed:the maximum value of systolic blood pressure in the poor prognosis group,the maximum value of diastolic blood pressure,the difference between the maximum and minimum systolic blood pressure,the difference between the maximum and minimum diastolic blood pressure,the standard deviation of systolic blood pressure,the standard deviation of diastolic blood pressure,the coefficient of variation of systolic blood pressure,and the coefficient of variation of diastolic blood pressure were significantly higher than those with good prognosis.The final multivariate adjustment model showed that the mean systolic blood pressure was not the main difference between the twogroups,the difference being the maximum value of systolic and diastolic blood pressure,the difference between the maximum and minimum values,the standard deviation and the coefficient of variation.(4)The multivariate/adjusted model results including only systolic blood pressure support the complete model.The maximum systolic blood pressure,the difference between the maximum and minimum systolic blood pressure,the standard deviation,and the coefficient of variation were significantly higher in the poor prognosis group than in the good prognosis group: 153.23±18.91 vs 145.76±21.87,P<0.05;23.21±10.01 vs14.76 ± 11.03,p < 0.001;8.06 ± 3.31 vs 5.06 ± 3.67,p < 0.001;0.051 ± 0.02 vs 0.031 ±0.03,p < 0.001.The mean and minimum values of systolic blood pressure were not significantly different between the two groups.(5)In a model including a baseline NIHSS score as a covariate and a 3-month mRS score as a binary variable(≤2 for good results or >2 for poor outcome),the results were compared with the 3-month mRS corrected by the baseline NIHSS score.The model of the score was similar: the maximum value of systolic blood pressure in the poor prognosis group,the maximum value of diastolic blood pressure,the difference between the maximum and minimum systolic blood pressure,the difference between the maximum and minimum diastolic blood pressure,the standard deviation of systolic blood pressure,and the diastolic blood pressure.The standard deviation,the coefficient of variation of systolic blood pressure,and the coefficient of variation of diastolic blood pressure were significantly higher than those with good prognosis.The only difference is that for those patients with good results,the mean diastolic blood pressure is significantly higher.2.According to the parameters of blood pressure variation,all patients were divided into The smaller BPV group and The larger BPV group.The general characteristics,blood pressure parameters,mRS score and prognosis of the two groups were compared as follows:(1)There was no significant difference in age,male to female ratio and NIHSSscore at admission,but there was significant difference in NIHSS score at 3 months between the two groups.(2)SD and CV of systolic blood pressure and diastolic blood pressure were significantly higher in the larger BPV group than those in smaller BPV group,and the difference was statistically significant.(3)The difference of mRS score between the two groups at 3 months was statistically significant.(4)According to Spearman rank correlation test,there was a significant correlation between BPV and 3-month prognosis in the two groups.Conclusion:1.BPV in acute ischemic stroke patients with ICAO was negatively correlated with poor clinical prognosis.2.The higher the maximum systolic pressure and diastolic pressure in acute ischemic stroke patients with ICAO,the greater the pulse pressure difference and the worse the prognosis.3.The mean systolic pressure in acute ischemic stroke with ICAO was not related to the clinical prognosis. |
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