Blood pressure variability and early neurological deterioration in high-risk patients with acute minor stroke or transient ischemic attack

doi:10.3877/cma.j.issn.1674-0785.2019.12.003

Abstract

Abstract:

Objective

To analyze the relationship between blood pressure (BP) variability (BPV) and early neurological deterioration (END) in high-risk patients with acute minor stroke or transient ischemic attack.

Methods

Patients with acute minor stroke or transient ischemic attack were consecutively recruited at the Affiliated Hospital of Yangzhou University between May 2017 and May 2019 and divided into two groups according to the presence of END or not. During the first 72 hours, the parameters of BPV such as BP_max, BP_max-min, BP_SD, and BP_CV were calculated.

Results

A total of 102 patients were recruited in this study, of whom 27 (26.5%) developed END. Univariate analysis indicated that age, sex, white blood cell count, C reactive protein, and BPV parameters such as SBP_max-min, SBP_SD, SBP_CV, DBP_max-min, DBP_SD, and DBP_CV were significantly associated with the development of END (P<0.05). After adjusting the parameters with a P-value< 0.1, logistic regression analysis demonstrated that SBP_max-min (1.026 [1.002-1.050]), SBP_SD (1.124 [1.006-1.256]), SBP_CV (1.277 [1.068-1.526]), DBP_max-min (1.084 [1.021-1.151]), DBP_SD (1.560 [1.166-2.088]), and DBP_CV (1.439 [1.154-1.793]) were all independently associated with the development of END in high-risk patients with acute minor stroke or transient ischemic attack.

Conclusion

Our study indicated that higher in-hospital BPV may increase the risk of END in high-risk patients with acute minor stroke or transient ischemic attack.

Key words: Ischemic attack, transient, Minor stroke, Early neurological deterioration, Blood pressure variability

Zuowei Duan, Ming Yang, Yanyu Zheng, Lihong Tao, Bin Chen. Blood pressure variability and early neurological deterioration in high-risk patients with acute minor stroke or transient ischemic attack[J]. Chinese Journal of Clinicians(Electronic Edition), 2019, 13(12): 893-897.

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References 28

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临床特征		END组（27例）	非END组（75例）	统计值	P值
年龄（岁，±s）		67.63±12.46	61.16±11.43	t=2.463	0.016
女性［例（%）］		17（63.0）	27（36.0）	χ²=5.884	0.015
高血压［例（%）］		19（70.4）	45（60.0）	χ²=0.913	0.339
糖尿病［例（%）］		12（44.4）	25（33.3）	χ²=1.060	0.303
高脂血症［例（%）］		8（29.6）	24（32.0）	χ²=0.052	0.820
冠心病［例（%）］		10（37.0）	17（22.7）	χ²=2.106	0.147
吸烟［例（%）］		8（29.6）	28（37.3）	χ²=0.516	0.473
饮酒［例（%）］		8（29.6）	16（21.3）	χ²=0.759	0.384
基线NIHSS［M（Q_R）］		2（1~2）	1（0~2）	Z=-0.606	0.545
白细胞（×10⁹，±s）		8.18±2.84	7.05±1.90	t=2.323	0.022
红细胞（×10¹²，±s）		4.49±0.54	4.41±0.57	t=0.684	0.495
空腹血糖（mmol/l，±s）		6.76±2.66	6.62±2.96	t=0.224	0.823
C反应蛋白（mg/l，±s）		18.36±13.09	9.79±13.96	t=2.780	0.007
治疗方式［例（%）］		?	?	χ²=2.687	0.261
?	常规药物	25（92.6）	72（96.0）	?	?
?	静脉溶栓	1（3.7）	3（4.0）	?	?
?	动脉取栓	1（3.7）	0	?	?
SBP		?	?	?	?
?	SBP_mean	139.26±13.32	142.90±9.73	t=-1.507	0.135
?	SBP_max	182.44±24.70	172.66±28.10	t=1.599	0.113
SBP_max-min		76.15±23.10	62.31±21.10	t=2.850	0.005
?	SBP_SD	17.20±4.27	14.17±4.77	t=2.903	0.005
?	SBP_CV	12.46±2.90	10.05±2.94	t=3.668	0.000
DBP		?	?	?	?
?	DBP_mean	79.79±5.91	80.78±4.09	t=-0.948	0.346
?	DBP_max	98.59±7.50	94.88±8.93	t=1.928	0.057
DBP_max-min		34.37±11.59	28.47±8.56	t=2.787	0.006
?	DBP_SD	8.11±2.26	6.74±1.83	t=3.119	0.002
?	DBP_CV	10.48±3.25	8.40±2.42	t=0.146	0.001

临床特征		END组（27例）	非END组（75例）	统计值	P值
年龄（岁，±s）		67.63±12.46	61.16±11.43	t=2.463	0.016
女性［例（%）］		17（63.0）	27（36.0）	χ²=5.884	0.015
高血压［例（%）］		19（70.4）	45（60.0）	χ²=0.913	0.339
糖尿病［例（%）］		12（44.4）	25（33.3）	χ²=1.060	0.303
高脂血症［例（%）］		8（29.6）	24（32.0）	χ²=0.052	0.820
冠心病［例（%）］		10（37.0）	17（22.7）	χ²=2.106	0.147
吸烟［例（%）］		8（29.6）	28（37.3）	χ²=0.516	0.473
饮酒［例（%）］		8（29.6）	16（21.3）	χ²=0.759	0.384
基线NIHSS［M（Q_R）］		2（1~2）	1（0~2）	Z=-0.606	0.545
白细胞（×10⁹，±s）		8.18±2.84	7.05±1.90	t=2.323	0.022
红细胞（×10¹²，±s）		4.49±0.54	4.41±0.57	t=0.684	0.495
空腹血糖（mmol/l，±s）		6.76±2.66	6.62±2.96	t=0.224	0.823
C反应蛋白（mg/l，±s）		18.36±13.09	9.79±13.96	t=2.780	0.007
治疗方式［例（%）］		?	?	χ²=2.687	0.261
?	常规药物	25（92.6）	72（96.0）	?	?
?	静脉溶栓	1（3.7）	3（4.0）	?	?
?	动脉取栓	1（3.7）	0	?	?
SBP		?	?	?	?
?	SBP_mean	139.26±13.32	142.90±9.73	t=-1.507	0.135
?	SBP_max	182.44±24.70	172.66±28.10	t=1.599	0.113
SBP_max-min		76.15±23.10	62.31±21.10	t=2.850	0.005
?	SBP_SD	17.20±4.27	14.17±4.77	t=2.903	0.005
?	SBP_CV	12.46±2.90	10.05±2.94	t=3.668	0.000
DBP		?	?	?	?
?	DBP_mean	79.79±5.91	80.78±4.09	t=-0.948	0.346
?	DBP_max	98.59±7.50	94.88±8.93	t=1.928	0.057
DBP_max-min		34.37±11.59	28.47±8.56	t=2.787	0.006
?	DBP_SD	8.11±2.26	6.74±1.83	t=3.119	0.002
?	DBP_CV	10.48±3.25	8.40±2.42	t=0.146	0.001

血压参数		校正前OR（95%CI）	校正后OR（95%CI）^a
SBP		?	?
?	SBP_mean	0.970（0.933~1.010）	0.996（0.921~1.013）
?	SBP_max	1.013（0.997~1.030）	1.013（0.994~1.032）
SBP_max-min		1.028（1.007~1.049）	1.026（1.002~1.050）
?	SBP_SD	1.143（1.036~1.260）	1.124（1.006~1.256）
?	SBP_CV	1.294（1.106~1.513）	1.277（1.068~1.526）
DBP		?	?
?	DBP_mean	0.957（0.873~1.049）	0.919（0.826~1.023）
?	DBP_max	1.049（0.998~1.102）	1.033（0.976~1.094）
DBP_max-min		1.064（1.015~1.116）	1.084（1.021~1.151）
?	DBP_SD	1.398（1.108~1.764）	1.560（1.166~2.088）
?	DBP_CV	1.308（1.104~1.549）	1.439（1.154~1.793）

血压参数		校正前OR（95%CI）	校正后OR（95%CI）^a
SBP		?	?
?	SBP_mean	0.970（0.933~1.010）	0.996（0.921~1.013）
?	SBP_max	1.013（0.997~1.030）	1.013（0.994~1.032）
SBP_max-min		1.028（1.007~1.049）	1.026（1.002~1.050）
?	SBP_SD	1.143（1.036~1.260）	1.124（1.006~1.256）
?	SBP_CV	1.294（1.106~1.513）	1.277（1.068~1.526）
DBP		?	?
?	DBP_mean	0.957（0.873~1.049）	0.919（0.826~1.023）
?	DBP_max	1.049（0.998~1.102）	1.033（0.976~1.094）
DBP_max-min		1.064（1.015~1.116）	1.084（1.021~1.151）
?	DBP_SD	1.398（1.108~1.764）	1.560（1.166~2.088）
?	DBP_CV	1.308（1.104~1.549）	1.439（1.154~1.793）

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