Clinical Study On The Changes Of Cardiac Structure And Function After Essential Hypertension Complicated With Acute Stroke

Objectives: To investigate the changes and influencing factors of cardiac structure and function in patients with essential hypertension complicated with acute ischemic stroke(AIS)or acute cerebral hemorrhage(ACH).Methods: From January 2017 to October 2022,34 patients with essential hypertension,75 patients with essential hypertension complicated with AIS and 50 patients with essential hypertension complicated with ACH were admitted to the Department of Neurology,Cardiovascular Medicine and Cerebrovascular Diseases of xx Hospital.Procalcitonin(PCT),interleukin-6(IL-6)and color Doppler ultrasonography of cervical vessels were collected during admission.Myocardial injury markers,transthoracic echocardiography,24 small ambulatory blood pressure and ambulatory electrocardiogram are all used as indexes to evaluate the changes of cardiac structure and function.The myocardial injury markers include creatine kinase isoenzyme(CK-MB),myoglobin(MYO),N-terminal pro-B-type natriuretic peptide(NT-pro BNP)and high sensitivity troponin T(hs-Tn T).The indexes of transthoracic echocardiogra-phy included left ventricular ejection fraction(LVEF),left ventricular short axis shortening(FS),cardiac output(SV),cardiac output(CO),EA < 1,left ventricular end-diastolic diameter(LVDd),left atrial diameter(LAD),right ventricular end-diastolic diameter(RVDd),right atrial diameter(RAD).24-hour ambulatory blood pressure indexes: 24-hour mean systolic blood pressure(24hm SBP),24-hour mean diastolic blood pressure(24hm DBP),daytime mean systolic blood pressure(dm SBP),daytime mean diastolic blood pressure(dm DBP),nocturnal mean systolic blood pressure(nm SBP),nocturnal mean diastolic blood pressure(nm DBP).24-hour dynamic electrocardiogram indexes: heart rate variability(HRV)included standard deviation of the R-R interval(SDNN),root mean square of successive RR interval differences(r MSSD),percentage of the number of pairs of adjacent R-R intervals differing by more than 50 ms(p NN50),standard deviation of the average NN intervals(SDANN),presence or absence of ST-T segment or T wave changes,and cardiac arrhythmia.SPSS25.0 software and Graph Pad Prism9 were used for statistical analysis to compare the differences between the above three groups in terms of indicators related to cardiac structure and function.Spearman analysis was used to analyze the correlation between PCT and IL-6 levels and indicators related to cardiac structure and function in patients with essential hypertension combined with acute stroke(AS).Results:1 The differences were not statistically significant(P >0.05)when comparing gender,history of diabetes mellitus,history of smoking,history of alcohol consumption,history of stroke,and carotid intima-media thickening in the three groups,but the combined AIS group was older than the essential hypertension group,and the differences were statistically significant(adjusted P < 0.05).2 Age was included in univariate Logistic regression analysis to analyze the effect of age on AIS in patients with essential hypertension.The results showed that age had an effect on AIS in patients with essential hypertension(P=0.005,OR=1.056,95%CI: 1.016-1.098)3 The level of NT-pro BNP in ACH group was higher than that in essential hypertension group,and the difference was statistically significant(adjusted P <0.05).The LVEF in the group with AIS was lower than that in the group with essential hypertension,and the difference was statistically significant(adjusted P < 0.05).The levels of SV and CO in patients with AIS were significantly lower than those in patients with essential hypertension(adjusted P < 0.05).The levels of SV and CO in patients with ACH were significantly lower than those in patients with essential hypertension(adjusted P < 0.05).Compared with the essential hypertension group,the proportion of E / A < 1 in the group with AIS and group with AIS was higher,and the difference was statistically significant(adjusted P < 0.05)The levels of SDNN,p NN50 and SDANN in the group with ACH were significantly lower than those in the group with essential hypertension,and the levels of SDNN,p NN50 and SDANN in the group with ACH were lower than those in the group with AIS(adjusted P < 0.05).The r MSSD in the group with ACH was lower than that in the group with essential hypertension,and the difference was statistically significant(adjusted P < 0.05).The levels of 24 hm SBP,nm SBP and nm DBP in essential hypertension group were significantly lower than those in AIS group and ACH group(adjusted P < 0.05).The levels of 24 hm DBP and dm SBP in essential hypertension group were significantly lower than those in ACH group(adjusted P < 0.05).4 SDNN,r MSSD,SDANN,p NN50 were negatively correlated with serum PCT levels in patients with essential hypertension complicated with AS(P < 0.05),but not with serum IL-6 levels(P >0.05).There was no correlation between serum PCT,IL-6and CK-MB,MYO,hs-Tn T,NT-pro BNP,24 hm SBP,24 hm DBP,dm SBP,dm DBP,nm SBP and nm DBP in patients with essential hypertension complicated with AS(P >0.05).Conclusions:1.Age is a risk factor for AIS in patients with essential hypertension.2.The cardiac systolic function,the imbalance of cardiac autonomic rhythm and the ability of peripheral blood pressure regulation were affected in patients with essential hypertension complicated with AS,among which the disorder of cardiac autonomic rhythm and the weakening of peripheral blood pressure regulation ability were more serious in patients with essential hypertension complicated with ACH.3.In patients with essential hypertension complicated with AS,the higher the level of serum PCT,the easier it is to disrupt the rhythm of cardiac autonomic activity.