The Clinical Research Of The Acute Cerebral Infarction Patients With Orthostatic Blood Pressure Change

Background: Orthostatic hypertension and orthostatic hypotension are associated with a variety of cardiovascular and cerebrovascular diseases.Some studies found postural blood pressure changes have a higher prevalence of stroke in the population,which may be an independent risk factor for stroke, and it can be used as predictors of stroke.Cerebral infarction which is the most common emergency in neurology has a high morbidity and mortality.So observing and analyzing the prevalence and related factors of the acute cerebral infarction patients with orthostatic blood pressure change can provide clinical basis for the prevention.Objective: To investigate prevalence of orthostatic hypotension and orthostatic hypertension in acute cerebral infarction group, to observe its clinical characteristics and to explore associated risk factors of orthostatic blood pressure change; To assess cognitive impairment associated with orthostatic blood pressure change.To analysis the distribution of the cognition field impaired by acute cerebral infarction with orthostatic blood pressure change.Methods: Take the acute cerebral infarction patients in the neurology department of the 2th clinical hospital of jilin university from April 2015 to Feberary 2016 as our research tarket.The orthostatic blood pressure were measured in supine position and after standing(0 min,1min,2min) from 7:00 am. to 9:00 am, divided the patients into orthostatic hypotension(OH) groups, orthostatic hypertension(OHT) group and orthostatic blood pressure normaltention(ONT) according to the blood pressure.Basic clinical data,blood biochemical indexes, carotid ultrasound and head MRI examination results were evaluated and analyzed. At the same time assess the cognitive function by Chinese version of the MOCA and MMSE, and according to the score, divided the patients into cognitive impairment group and the cognitive disimpairment group. Analyze possible risk factors.Results: 1.Among 164 hospitalized patients with acute cerebral infarction, the average age is 65 years old, including 91 males, 73 female, and there are 23 cases(14.02%) with OH,18 cases(10.98%) with OHT, 123 cases(75.00%) with ONT. 2. The heart rate change of decubitus and after standing 0 min, 1 min, 2 min were similar among the three groups. 3. The average age, gender ratio, degree and BMI in OH and OHT were both similar with the ONT group. The incidence of hypertension, coronary heart disease,diabetes,hyperlipidemia, smoking history,history of drinking, cerebrovascular stenosis, Leukoaraiosis were similar among the three groups. But the proportion of patients of OH and OHT group with hypertension, diabetes, coronary heart disease and Leukoaraiosis is higher than the ONT group.The location, amount and volume of the cerebral infarction in the three groups has no statistical difference.4.The ration of using antihypertensive medication in OH,OHT group were higher than that in ONT group(P < 0.05).5.The incidence of dizziness while position changes in OH group is significantly higher than the ONT group(P < 0.05). Sleeping disorders and autonomic nerve symptom such as dry mouth, dry eye were similar among the three groups. 6. The scores of MOCA and MMSE were lower than that of ONT group,there are statistical difference(P<0.05). 7.With single factor analysis, it found that the lower MOCA score was associated with Leukoaraiosis,application of antihypertensive drugs, higher age and degree,which has statistical difference(P < 0.05). After a number of factors of logistic analysis: only degree has significant linear relationship with cognitive impairment. 8. The main areas with low cognitive scores in OH group was visual, delayed memory areas,the main areas with low scores in OHT group was the main areas with low scores in OH group was visual, delayed memory areas.The three groups all get lower score in abstract ability area.Conclusion: 1. OH and OHT group are quite common in the patients with acute cerebral infarction.2.The occurrence of OH and OHT are related with antihypertensive drugs application.3.Among the patients with acute cerebral infarction, OH and OHT may be not significiantly associated with age, education, BMI, gender constituent ratio, high cholesterol, tobacco history, cerebrovascular stenosis.The number of cerebral lesions, location and infarct volume may be irrelevant. OH and OHT group have higher prevalence of hypertension, diabetes, coronary heart disease, osteoporosis white matter than ONT group.4.The patients in OH group were easier to feel dizzy when changing the position than the patients in ONT.5.Compared with ONT, OH and OHT are more likely to have cognitive impairment.6.Cognitive decline was associated with Leukoaraiosis,application of antihypertensive drugs, higher age and degree, among them the influence of degree on cognitive function is the largest. Postural changes in blood pressure man be not independent risk factor for cognitive impairment.