Effect Of Intensive Blood Pressure Management On Risk Of Recurrent Stroke In Middle-aged Patients With Cerebral Infarction

Background:Stroke has become the first cause of death and disability among adults in China,with the characteristics of high incidence,prevalence,recurrence and disability rate,of which about 83% are ischemic stroke.Middle-aged people,As the backbone of society,often brings heavier economic burden to the family and society,and the second recurrence often leads to more serious disability and outcome.Previous studies have found that intensive blood pressure lowering may reduce the recurrence rate of stroke.However,at present,the standard of blood pressure management is still controversial at home and abroad,and there is no classification of age.Objective:(1)The effect of intensive blood pressure management on the recurrence of middleaged cerebral infarction.(2)The effect of intensive blood pressure management on arteriosclerosis in middleaged patients with cerebral infarction.(3)The effect of intensive blood pressure management on neurological function in middle-aged patients with cerebral infarction.Methods:A randomized and clinical controlled trial was used in this study.A total of273 patients with hypertension and cerebral infarction hospitalized in the Department of Neurology of Xi ’an Central Hospital from November 2020 to December 2021 were recruited and randomly divided into 3 groups according to the ratio of 1:1:1.Basic information and clinical data were collected,and blood pressure management was performed.Thirty-six subjects were excluded due to atrial fibrillation,intracranial and extracranial large vessel stenosis,lost follow-up and other factors,and 237 subjects were finally entered into the final analysis.They were: standard antihypertensive group: blood pressure<140/90 mm Hg;Intensive antihypertensive group: blood pressure < 130/80 mm Hg;Control group: no intervention.Blood routine test,blood glucose,blood lipid,liver function,kidney function,coagulation picture,electrocardiogram and scale scores(NIHSS,mRS Scale)were reexamined at 3 months,6 months and 1 year after enrollment.Cardiac and neck vascular ultrasound was reexamined every six months.The relevant conditions of patients were recorded,and the evidence materials of family blood pressure and stroke events were collected in time.Primary endpoints were recurrent fatal or non-fatal stroke events,cardiovascular death,etc.Secondary endpoints were acute myocardial infarction,unstable angina(diagnosed as coronary atherosclerotic stenosis),new-onset heart failure and all-cause death.Results:(1)Comparison of clinical baseline data,there was no statistical significance in age,gender,smoking history,diabetes history,coronary heart disease history,medication history,enrolled blood pressure,scale score,blood lipid,liver and kidney function among the three groups(P > 0.05).(2)After one year of blood pressure management,there was no statistical significance in stroke recurrence rate among the three groups(P > 0.05).(3)After one year of blood pressure management,there was a statistically significant difference in the incidence of cardiovascular events between the intensive antihypertensive group and the control group(P < 0.05).(4)After one year of blood pressure management,tthe levels of total cholesterol,triglyceride,low-density lipoprotein cholesterol and carotid atherosclerotic plaques in the intensive antihypertensive group were statistical significance from those in the control group(P < 0.05).(5)After one year of blood pressure management,there was no statistical significance in NIHSS and mRS Scores among the three groups(P > 0.05).Conclusion:(1)Intensive blood pressure management(BP < 130/80 mm Hg)did not significantly reduce the one-year recurrence rate of stroke in middle-aged patients with cerebral infarction,but it could reduce the incidence of cardiovascular events.(2)Intensive blood pressure management(BP < 130/80 mm Hg)improved the levels of triglyceride,total cholesterol and low-density lipoprotein cholesterol in middle-aged patients with cerebral infarction,and delayed the formation of carotid atherosclerosis plaque.(3)Intensive blood pressure management(BP < 130/80 mm Hg)did not significantly improve the neurological status of middle-aged patients with cerebral infarction.