ABSTRACT
Objective To investigate the effect of blood pressure variability on early neurological deterioration (END) in patients with acute minor stroke or high-risk transient ischemic attack (TIA).Methods Consecutive patients with acute minor stroke or high-risk TIA admitted to the Department of Neurology, the Affiliated Hospital of Yangzhou University between March 2017 and December 2018 were enrolled prospectively. Minor stroke was defined as the National Institutes of Health Stroke Scale (NIHSS)score ≤3, and high-risk TIA was defined as ABCD2 score ≥4. The blood pressure monitored within 72 h after admission was analyzed. The mean, maximum (max), range (max-min), standard deviation (SD), and coefficient of variation (CV) of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were calculated. END was defined as highest NIHSS score increase ≥ 2 at re-evaluation within 72 h after admission compared with the baseline score. Multivariate logistic regression analysis was used to determine the independent correlation between blood pressure variability parameters and END. Results A total of 123 patients were enrolled in the study, including 54 females (43. 90％) and 69 males (56. 10％), aged (63. 74 ± 11. 94) years. Thirty-nine (31. 71％) of them were high-risk TIA, 84 (68. 29％) were minor strokes. END occurred in 33 patients (26. 8％) within 72 h on admission. Univariate analysis showed that there were significant differences in age, gender, white blood cell count, C-reactive protein, and SBPmax-min , SBPSD ,SBPCV, DBPmax-min , DBPSD , and DBPCV between the END group and the non-END group (all P < 0. 05).Multivariate logistic regression analysis showed that after adjusting for confounding factors, SBPmax-min (odds ratio [OR] 1. 019, 95％ confidence interval [CI] 1. 001-1. 038), SBPSD (OR 1. 099, 95％ CI 1. 005-1. 201),SBPCV(OR 1. 320, 95％ CI 1. 124-1. 550), DBPmax-min (OR 1. 065, 95％ CI 1. 017-1. 114), DBPSD (OR 1. 492,95％ CI 1. 186-1. 877), and DBPCV(OR 1. 543, 95％ CI 1. 263-1. 886) were the independent risk factors for END within 72 h on admission in patients with acute minor stroke or high-risk TIA. Conclusion Multiple blood pressure variability parameters are significantly independently correlated with the risk of END in patients with acute minor stroke or high-risk TIA.
ABSTRACT
Objective To investigate the correlation between blood pressure variability (BPV) and early neurological deterioration (END) in patients with acute anterior circulation large artery atherosclerotic (LAA)stroke. Methods From January 2015 to June 2018, consecutive patients with anterior circulation acute ischemic stroke admitted to the Department of Neurology, the Affiliated Hospital of Yangzhou University were enrolled prospectively. According to the etiological classification, they were divided into LAA group and non-LAA group. By monitoring the blood pressure within 72 h of hospitalization, the mean, maximum (max)and minimum (min) values, and the difference between max and min (max-min), standard deviation (SD),and coefficient of variation (CV; CV = SD × 100/mean) were calculated. END was defined as the highest score of the National Institutes of Health Stroke Scale (NIHSS) within 72 h of admission increased by ≥2than the baseline. Multivariate logistic regression analysis was used to determine the correlation between BPV parameters and END. Results A total of 271 patients with anterior circulation acute ischemic stroke were enrolled, including 101 females (37. 3％) and 170 males (62. 7％), with an average age of 64. 99 ± 11. 51 years. There were 95 patients (35. 1％) with LAA and 176 (64. 9％) with non-LAA. In the LAA group and non-LAA group, 36 patients (37.9％) and 50 patients (28.4％) developed END respectively. The comparison between END patients and non-END patients in the LAA group showed that there were significant differences in age, sex, diabetes mellitus, baseline NIHSS score and C-reactive protein, as well as SBPmax , SBPmax-min , SBPSD , SBPCV, DBPmax , DBPmax-min , DBPSD , and DBPCV in BPV indices (all P < 0. 05).Multivariate logistic regression analysis showed that many BPV indices were the independent risk factors for END, including SBPmax (odds ratio [OR] 1. 027, 95％ confidence interval [CI] 1. 003-1. 052; P = 0. 027),SBPmax-min (OR 1. 041, 95％CI 1. 015-1. 068; P = 0. 002), SBPSD (OR 1. 177, 95％ CI 1. 048-1. 322; P =0. 006), SBPCV (OR 1. 226, 95％ CI 1. 036-1.451; P = 0. 018), DBPmax (OR 1. 073, 95％ CI 1. 017-1. 133;P = 0. 010), DBPmax-min (OR 1. 107, 95％CI 1. 044-1. 174; P = 0. 001), DBPSD (OR 1. 693, 95％CI 1. 268- 2. 260; P < 0. 001), and DBPCV(OR 1. 726, 95％CI 1. 311-2. 271; P < 0. 001). In the non-LAA group, there were no significant association between all BPV parameters and the occurrence of END. Conclusion BPV was significantly correlated with END in patients with anterior circulation LAA.