The Feature Of 24h Ambulatory Blood Pressure Of The Patients In Cerebral Microbleeds With Lacunar Infarction

Objective: Both lacunar infarction and cerebral microbleeds are belong to cerebral small vessel diseases.Most patients with cerebral small vessel disease see a doctor,due to the clinical symptoms of lacunar infarction.For example,limb weakness,dysarthria,dysphagia,ataxia,hemidysesthesia.CMBs is characterized by brain subclinical damage caused by the brain microvascular repture or leak.It has not obvious clinical symptoms,but it is with clinical significance.With the rapid development and widespread application of head magnetic resonance,CSVD receives more and more attention from the medical profession.The recent studies have found that hypertension is closely related to CSVD.So the research aims to explore the feature of 24 h ambulatory blood pressure of the patients in cerebral microbleeds with lacunar infarction.And under the reasonable control of blood pressure,through two-year follow-up,observe the recurrence rate of lacunar infarction.Methods: From March 2013 to December 2015,a total of 93 patients with lacunar infarction combined hypertension,who were admitted to the Second Affiliated Hospital of Hebei Medical University,Department of Neurology were enrolled in the study.Recorded the basic clinical datum of all the patients,including age,gender,height,weight,education years,previous medical history of hypertension,diabetes,smoking history,imaging datum(including MRI+MRA+DWI+SWI),the result of 24 h ambulatory blood pressure monitoring(ABPM),biochemical information,electrocardiogram,carotid artery ultrasound,MMSE score,MoCA score and so on.The patients would be followed by telephone calls or outpatient services,at the first month,the third month,and the twelfth month,consulting the condition of anti-hypertension drug taking,the control level of blood pressure and the recurrence of stoke.If the control level of blood pressure was not ideal,guide the adjustment of anti-hypertension drug,to stable blood pressure level at 130-140/80-90 mmHg.At the end of two-year follow-up,Imaging datum(including MRI+MRA+DWI+SWI),24 h ambulatory blood pressure monitoring(ABPM),electrocardiogram,carotid artery ultrasound,MMSE score,Mo CA score were examined.Under the reasonable control of blood pressure,the recurrence of lacunar infarction could be reduced whether or not.According to susceptibility weighted imaging(SWI),the patients were divided into two groups.One was CMBs group,the other was non-CMBs group.To explore the feature of 24 h ambulatory blood pressure of the patients in cerebral microbleeds with lacunar infarction.Results:1 Totally 94 patients were involved in the research,55 0f which with cerebral microbleeds were processed as CMBs group,31 cases(56.36%)were male,the average age was 57.03±6.09.And 38 of which without cerebral microbleeds as non-CMBs group.22 cases(57.89%)were male,the average age was57.34±9.25.The basic clinical datum between the two group were not statistically significant(P>0.05).2 The patients with CMBs were more likely to have a higher 24 h SBP,24 hDBP,DSBP,DNDP,NSBP,NDBP than patients without CMBs.The difference was significant(P<0.05).3 In CMBs group,5 cases with the dipper type blood pressure rhythm;in non-CMBs group,10 cases with the dipper type blood pressure rhythm.The difference was significant(P=0.026).4 A total of 62 cases were finished one-year follow-up.1 case lost follow-up.2 cases is unsatisfied with the blood pressure level.59 case were with no clinical recurrence,under the stable blood pressure level.5 A total of 17 cases were finished two-year follow-up.2 cases lost follow-up.1case was of recurrence.Not only 14 cases were with no clinical recurrence,but also there were no new lesion on their imaging tests.Conclusion:1 Not only CMBs is associated with higher blood pressure level,but also accompanied with the disappearance of blood pressure rhythm.2 By the control of blood pressure at a reasonable level,the recurrence of lacunar infarction can be reduced.