The Relationship Between Cerebral Microbleeds And Blood Pressure Variability In Ischemic Stroke Patients

Background:Cerebral microbleeds(CMBs),a small old leak of blood from damaged small vessel of brain,were wildly known as the development of neuroimage.and the detection rate of CMBs is getting higher and higher,especially in people with ischemic stroke.Hypertension is an important and controllable risk factor for CMBs.At present,the application of ambulatory blood pressure monitoring is more and more extensive,There are more and more studies between BPV and hypertension-related target organ damage.However,there are scanty reports about the relationship between ambulatory blood pressure and CSVD.Objective:To observe the 24h-hour ambulatory blood pressure characteristics in patients with ischemic stroke and investigate the relationship between cerebral microbleeds and blood pressure variability.Methods:A total of 121 acute ischemic stroke patients from the Department of Neurology,Shannxi Provincial People’s Hospital from January 2018 to January 2019,were selected.After admission to collect history and laboratory examination date,Calculated and recorded parameters related to BPV based on 24-hour ambulatory blood pressure monitoring results,In this study,patients were divided into two groups,one was CMBs group,the other was non-CMBs group.According to the burden of CMBs,there were zero(0),mild(1-5),moderate(6-10),and severe(>10).According to the location of CMBs,it was divided into brain lobes CMBs,deep CMBs,subtentorial CMBs,mixed CMBs four categories.According to the magnitude of the BP falls,subjects were divided into subgroups:normal rhythm group(dippers)and abnormal rhythm group(non-dippers,extreme dippers,reverse dippers).Data were analyzed using SPSS24.0,version 24.0,all tests were considered significance if p<0.05.Result:1.The levels of 24h SBP(OR=3.087,95%CI:2.386~6.856;P=0.002),24h SBP-CV(OR=4.188,95%CI:1.451~3.128;P=0.001),NDBP-CV(OR=2.339,95%CI:1.873~3.776;P=0.021),△DBP(OR=0.431,95%CI:0.998~2.887;P=0.015)were independent risk factors of CMBs.2.In this study,patients were divided into four groups according to the number of CMBs,Spearman correlation test by included ambulatory blood pressure parameters independently related to CMBs.The results showed that 24 hSBP(r=0.429,P=0.043),24h SBP-CV(r=0.127,P=0.005)and NDBP-CV(r=0.561,P=0.012)were positively correlated with the severity of CMBs;while△DBP(r=-0.672,P=0.047)was negatively correlated with the severity of CMBs.3.According to the diffreent parts of CMBs,divided into brain lobes CMBs,deep CMBs,subtentorial CMBs,mixed CMBs four categories.The results showed that 24h SBP-CV(OR=2.739,95%CI:2.873~6.771;P=0.041),NDBP-CV(OR=4.991,95%CI:3.091~9.667;P=0.019)and△DBP(OR=0.851,95%CI:2.901~10.661;P=0.032)were independent risk factors for deep CMBs;24h SBP-CV(OR=1.005,95%CI:2.887~4.092;P=0.046)and△DBP(OR=0.768,95%CI:2.743~4.661;P=0.041)were independent risk factors for subtentorial CMBs;DSBP-CV(OR=2.004,95%CI:2.986~7.025;P=0.032)、△SBP(OR=0.543,95%CI:1.075~7.620;P=0.043)were independent risk factors for mixed CMBs,There was no significant correlation between CMBs in lobes and blood pressure variability.4.According to the magnitude of the BP falls,the two groups were:normal rhythm group(dippers),abnormal rhythm group(non-dippers,extreme dippers,reverse dippers).The detection rate of CMBs in abnormal blood pressure rhythm group was higher than normal blood pressure rhythm group(x~2=4.398,P=0.042),the difference was statistically significant;In the abnormal blood pressure rhythm group,The detection rate of CMBs in the reverse dippers was higher than other groups(x~2=4.890,P=0.013),(x~2=8.920,P=0.004),and the difference was statistically significant.Conclusion:1.The Mean blood pressure and BPV were both risk factors for CMBs,The higher the mean blood pressure and BPV,the higher the incidence of CMBs.2.The 24hSBP,24hSBP-CV,NDBP-CV,△DBP were independent risk factors for CMBs.24 hSBP,24h SBP-CV,NDBP-CV were positively correlated with the severity of CMBs;△DBP was negatively correlated with the severity of CMBs.3.The 24h SBP-CV,NDBP-CV,△DBP were independent risk factors for CMBs in deep brain,24h SBP-CV,△DBP were risk factors for CMBs in subtentorial,DSBP-CV,△SBP were independent risk factors for mixed CMBs,brain lobes CMBs have nothing to do with BPV.4.The reverse dippers blood pressure was an important risk factor for CMBs,high blood pressure at night may promote the development of CMBs.5.The patients with CMBs should not only focus on even blood pressure and average blood pressure levels,but also need to perform ambulatory blood pressure monitoring to assess blood pressure variability and blood pressure rhythm.