Correlation Between TOAST Type And Early Antihypertensive Prognosis In Acute Ischemic Stroke

Objective:To explore the association between TOAST classification and the outcomes of acute phase antihypertensive treatment for acute ischemic stroke.Methods:613 patients with imaging-documented ischemic stroke and elevated blood pressure(non-thrombolysis)who were admitted to No.88 Hospital of PLA from August 2009 to May 2013 within 48 h of disease onset were randomly assigned to the antihypertensive treatment group(experimental group)or the non-hypertensive treatment group(control group).Patients in both the treatment and control groups received TOAST classification for subgroup analysis,and the patients’ blood pressure measures were recorded.Among the patients with ischemic stroke in the treatment group,blood pressure decreased by10-20% within 24 h of enrollment;the SBP and DBP had been lower than 140 mm Hg and90 mm Hg,respectively,within 7 days,and maintained at this level throughout the duration of hospitalization.Patients in the control group discontinued or did not received antihypertensive treatment.The blood measures were recorded.Patients were followed up at 3 months and 1 year after discharge to document the mortality and mortality/disability rate at 3 months and 1 year,and the recurrence at 1 year,so as to evaluate the effects of acute phase antihypertensive treatment on the outcome of ischemic stroke under the TOAST classification.Results:1.Comparison of baseline characteristics showed that patients in the two group groups had no significant differences in age,sex,medical history,prior medical history,disease onset time,blood pressure at admission,extent of neurologic deficit,blood glucose,cholesterol,or low-density lipoprotein,etc.(P>0.05),indicating general comparability of the baseline characteristics between the two groups.2.Among patients with the Large Artery Atherosclerosis(LAA)subtype of stroke,the 3-month mortality was significantly higher in the treatment group than in the control group,with statistically significant difference(P<0.05),while there were no statistically significant differences between the two groups in 3-month mortality/disability rate,1-year mortality and mortality/disability rate,or 1-year stroke recurrence rate(P>0.05);among patients with the Cardio Embolism(CE)subtype,the 3-month mortality was significantly higher in the treatment group than in the control group,with statistically significant difference(P<0.05),while there were no statistically significant differences between the two groups in 3-month mortality/disability rate,1-year mortality and mortality/disability rate,or 1-year stroke recurrence rate(P>0.05);among patients with the Small Artery Occlusion(SAO)subtype,the 3-month mortality was significantly lower,and the 1-year stroke recurrence rate was significantly higher in the treatment group than in the control group,both with statistically significant differences(P<0.05),while there were no statistically significant differences between the two groups in 3-month mortality/disability rate,or 1-year mortality and mortality/disability rate(P>0.05);the subgroups of Stroke of Other Determined Etiology(SOD)and Stroke of Undetermined Etiology(SUE)were not subject to statistical analysis due to the limited sample sizes.Conclusions:For the LAA subtype of ischemic stroke,antihypertensive therapy should be carefully executed,as it was associated with increased mortality 3 months;for the CE subtype,acute phase antihypertensive treatment might be beneficial,as it could reduce the 3-month mortality,which was associated with reduced exacerbation of cerebral edema and hemorrhagic transformation as the result of antihypotensive treatment;for the SAO subtype,acute phase antihypotensive did not change its outcome.