ABSTRACT
Objective:To investigate the correlation between circadian blood pressure pattern and heart rate variability and stroke severity and outcome in patients with acute ischemic stroke (AIS).Methods:Patients with first-ever AIS admitted to the Affiliated Qingdao Central Hospital of Qingdao University from January 2015 to January 2021 were retrospectively included. Ambulatory blood pressure monitoring (ABPM) and ambulatory electrocardiogram (AECG) were performed after admission. The severity of stroke was assessed according to the National Institutes of Health Stroke Scale. ≤8 were defined as minor stroke, and >8 were defined as moderate to severe stroke. The modified Rankin Scale was used to evaluate the clinical outcome at 3 months after onset. ≤ 2 were defined as good outcomes, and >2 were defined as poor outcomes. Multivariate logistic regression analysis was used to determine the independent influencing factors of stroke severity and outcome. Results:A total of 516 patients with AIS were enrolled, including 328 male (63.57%), aged 59.62±6.67 years old. Among them, 266 patients (51.55%) were in the minor stroke group and 250 (48.45%) were in the moderate to severe stroke group. There were 463 patients (89.73%) were in the good outcome group and 53 (10.27%) were in the poor outcome group. Multivariate logistic regression analysis showed that hypertension (odds ratio [ OR] 5.021, 95% confidence interval [ CI] 2.635-10.923; P<0.001), atrial fibrillation ( OR 3.896, 95% CI 2.574-8.521; P<0.001), circadian blood pressure pattern (non-dipper type: OR 2.436, 95% CI 1.031-4.749, P<0.001; reverse dipper type: OR 2.654, 95% CI 1.642-5.268, P<0.001), SDNN ( OR 0.298, 95% CI 0.114-0.730; P=0.002), SDANN ( OR 0.325, 95% CI 0.200-0.679; P=0.009), rMSSD ( OR 0.437, 95% CI 0.255-0.876; P=0.016) and pNN50 ( OR 0.369, 95% CI 0.291-0.767; P=0.013) were the independent influencing factors of stroke severity. Hypertension ( OR 4.857, 95% CI 1.957-8.552; P<0.001), baseline NIHSS score ( OR 2.189, 95% CI 1.597-3.315; P<0.001), stroke severity ( OR 3.853, 95% CI 2.316-5.958; P<0.001), circadian blood pressure pattern (non-dipper type: OR 2.997, 95% CI 1.128-5.430, P<0.001; reverse dipper type: OR 3.703, 95% CI 1.478-5.902; P<0.001), SDNN ( OR0.369, 95% CI 0.215-0.779; P=0.015), SDANN ( OR 0.372, 95% CI 0.198-0.862; P=0.018), rMSSD ( OR 0.455, 95% CI 0.314-0.896; P=0.026) and pNN50 ( OR 0.448, 95% CI 0.307-0.825; P=0.021) were the independent influencing factors of poor outcomes. Conclusion:The non-dipper and reverse dipper circadian blood pressure patterns and lower heart rate variability are independently associated with stroke severity and poor outcomes in patients with AIS.