Boserve of Clinical Significance and the Characteristics of Ambulatory Blood Pressure of Cerebral Infraction with Hypertension in Older
|Keywords||cerebral infraction hypertension AASI older hypertension ambulatory blood pressure monitor|
Background and ObjectiveArterial sclerosis development was recognized as one of the risk factors for causing ischemic cerebral vascular disease. And closely related with the long-time high blood pressure.There are a lot of index which can reflect arterial sclerosis, with the widespread use of 24-hours ambulatory blood pressure monitor in clinical practice. Whether the new index obtained from the ambulatory blood monitor, known as Ambulatory Arterial Stiffness Index (AASI),can reflect extent of arterial sclerosis and predict the complications of hypertension becomes a real topic. Studies have proved that the AASI significantly positively correlated with Carotid intima-media thickness, and was the independent predictors for atherosclerosis. But little is known about its predictive value for ischemic cerebral vascular disease in older patients with hypertension. The aim of this study is to observe the predictive value of AASI for cerebral infarction in older patients with hypertension, and the characteristics of the various indexes of ambulatory blood monitor in old hypertension patients and hypertension with cerebral infarction patients.MethodsFrom 2010/1/4 to 2011/3/2, the consecutive case of old than 60 years old hypertension and cerebral infarction patients occurred in 2 weeks registered at the wards or outpatient service of the First Affiliate Hospital of Zhengzhou University. All clinical characteristics and risk factors of cerebrovascular disease were collected, and given wear the Ambulatory blood pressure monitor. The Ambulatory Arterial stiffness index (AASI) and the basic Parameters can be obtain from the Ambulatory blood pressure monitor. The basic material and risk factors of the two groups were compared by Chi-square test and Variance analysis test, and the influential factors of cerebral infarction were analyzed by Logistic regression analysis.Results 158 cases more than 60 years old with cerebral infarction and high blood pressure with cerebral infarction.Among them simple hypertensive patients were 68, high blood pressure with cerebral infarction were 90. The age and gender were no difference among the two subgroups (P>0.05). The risk factors of cerebral infarction as smoking, Fat. TC. Homocysteine (HCY) were marked difference among the two groups (P<0.05). Logistic regression analysis showed that smoking, high Hcy, hyperlipidemia and diabetes were associated with cerebral infarction in old people (OR=2.557,2.568,2.544,2.348, P=0.034,0.014,0.012,0.044)The ambulatory blood pressure basic parameter display that 24 hour average systolic blood pressure, average diastolic pressure, daytime average systolic blood pressure and average diastolic pressure were difference among the two subgroups (P<0.05).While the night average systolic blood pressure and average diastolic pressure in cerebral infarction group were higher than that of pure hypertension group. The result was marked difference among the two groups (P<0.05).The AASI and 24 hour average pulse pressure gained from the ambulatory blood pressure was marked difference among the two groups (P<0.05). Logistic regression analysis showed that the AASI and 24 hour average pulse pressure were associated with cerebral infarction in old people(OR=2.964,2.616 P=0.001,0.020).The AASI was associated with Older hypertensive cerebral infarction independent of 24 hour average pulse pressure.Conclusion1. The ambulatory blood pressure basic parameter may reflect the prognosis of older hypertension.2. The AASI is better in reflecting the prognosis of older hypertension than 24 hour average pulse pressure.