The Effect Of Acute Antihypertensive Timing On The Clinical Prognosis Of Patients With Minor Stroke Complicated With ICAS

Objective:Elevated blood pressure is common in patients with acute ischemic stroke.Previous studies have supported the safety of acute antihypertensive therapy,but whether ischemic stroke patients can benefit from it remains controversial.Different clinical types of stroke and different timing of antihypertensive therapy may affect the effect of antihypertensive therapy.Our purpose is to investigate the effect of acute phase antihypertensive timing on the clinical prognosis of minor stroke with intracranial atherosclerotic stenosis(ICAS).Methods:This is a retrospective,observational clinical study based on the real world,including three sub-centers.We screened patients with minor ischemic stroke who were hospitalized in March,June,September and December of 2010,2012,2014,2016 and 2018 in the medical record system.Patients with ICAS were screened by transcranial Doppler(TCD)/ magnetic resonance angiography(MRA)/ CT angiography(CTA)/digital subtraction angiography(DSA).According to the time of antihypertensive treatment,the patients were divided into three groups,including the non-antihypertensive group.The early antihypertensive group(antihypertensive treatment within 24 hours of onset)and the delayed antihypertensive group(antihypertensive treatment after 24 hours of onset),and the non-antihypertensive group after onset was used as the reference group.The primary endpoint was in-hospital stroke recurrence,and the secondary endpoint was early neurologic deterioration(END).The safety endpoint was all types of bleeding events.Multivariate Cox and Logistic proportional hazards regression models were used to compare differences between groups.Results:A total of 580 mild ischemic stroke patients with ICAS were included in the study.Among them,47(8%)patients had in-hospital stroke recurrence,12(2%)patients had END,and 25(4%)patients had bleeding events.In the multivariate Cox proportional hazards regression model,antihypertensive therapy within 24 hours of onset was associated with a higher risk of stroke recurrence(HR 2.49,95 % CI 1.03,6.01;p = 0.043),without increasing the risk of bleeding events.In the multivariate Logistic proportional hazard regression model,antihypertensive therapy 24 hours after onset was associated with a lower risk of END(OR 0.11,95 % CI 0.2,0.6;P =0.011).Conclusion:Appropriate delay of antihypertensive treatment time can improve the clinical prognosis of patients with acute mild stroke complicated with ICAS.