Correlation between cerebral white matter lesions and blood pressure variability in patients with acute ischemic stroke

doi:10.11817/j.issn.1673-9248.2021.03.004

Abstract

Abstract:

Objective

To investigate the correlation between cerebral white matter lesions (WML) and blood pressure variability in patients with acute ischemic stroke.

Methods

Patients with acute ischemic stroke admitted to Beijing Tsinghua Changgung Hospital from January to November 2019 were retrospectively analyzed. The severity of WML was semi-quantitatively evaluated by Fazekas score and all patients were divided into marked WML group and mild WML group. Blood pressure variability was assessed by 24-hour ambulatory blood pressure monitoring. Univariate and multivariate analyses were performed on the general and specific variables related to blood pressure variability in the two groups, respectively, to evaluate the correlation between blood pressure variability and white matter lesions in patients with acute ischemic stroke.

Results

This study included 90 patients. 26 cases were women, and the mean (±SD) age was 66.2±11.9 years. 37.8% (34/90) of the patients had marked WML. Day-night systolic blood pressure dipping ratio was (3.4±8.0)%, and day-night diastolic blood pressure dipping ratio was (6.0±8.3)%. Abnormal day-night systolic blood pressure dipping and abnormal day-night diastolic blood pressure dipping were observed in 75.6% (68/90) and 70% (63/90) of patients, respectively. The age (OR=0.887, 95%CI: 0.829-0.949, P＜0.001) and abnormal day-night diastolic pressure dipping (OR=0.220, 95% CI: 0.065-0.806, P=0.022) for patients with acute ischemic stroke were independent risk factors for the severity of cerebral white matter lesions.

Conclusion

In patients with acute ischemic stroke, about 37.8% of patients have marked white matter lesions. Diurnal diastolic variation was found to be independent risk factor for severe white matter lesions in patients with acute ischemic stroke.

Key words: Stroke, White matter lesion, Blood pressure variability

Xiaofeng Zhang, Wendeng Xu, Jian Wu. Correlation between cerebral white matter lesions and blood pressure variability in patients with acute ischemic stroke[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2021, 15(03): 153-156.

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Figures/Tables 3

项目	数值
年龄（岁， $x ¯$ ±s）	66.2±11.9
女性[例（%）]	26（28.9）
高血压病史[例（%）]	67（74.4）
糖尿病病史[例（%）]	30（33.3）
高脂血症病史[例（%）]	48（53.3）
肾功能不全病史[例[例（%）]	8（6.9）
脑血管病家族史[例（%）]	20（22.2）
高同型半胱氨酸血症病史[例（%）]	40（44.4）
心房颤动病史[例（%）]	6（6.7）
吸烟史[例（%）]	44（48.9）
饮酒史[例（%）]	21（23.3）
当前血压收缩压（mmHg， $x ¯$ ±s）	142.1±14.6
日-日血压标准差（mmHg， $x ¯$ ±s）	9.2±4.1
日-日血压变异系数（%， $x ¯$ ±s）	6.5±3.0
昼-夜收缩压下降率（%， $x ¯$ ±s）	3.4±8.0
昼-夜异常收缩压下降[例（%）]	68（75.6）
昼-夜舒张压下降率（%， $x ¯$ ±s）	6.0±8.3
昼-夜异常舒张压下降（%， $x ¯$ ±s）	63（70.0）
显著脑白质病变[例（%）]	34（37.8）

项目	数值
年龄（岁， $x ¯$ ±s）	66.2±11.9
女性[例（%）]	26（28.9）
高血压病史[例（%）]	67（74.4）
糖尿病病史[例（%）]	30（33.3）
高脂血症病史[例（%）]	48（53.3）
肾功能不全病史[例[例（%）]	8（6.9）
脑血管病家族史[例（%）]	20（22.2）
高同型半胱氨酸血症病史[例（%）]	40（44.4）
心房颤动病史[例（%）]	6（6.7）
吸烟史[例（%）]	44（48.9）
饮酒史[例（%）]	21（23.3）
当前血压收缩压（mmHg， $x ¯$ ±s）	142.1±14.6
日-日血压标准差（mmHg， $x ¯$ ±s）	9.2±4.1
日-日血压变异系数（%， $x ¯$ ±s）	6.5±3.0
昼-夜收缩压下降率（%， $x ¯$ ±s）	3.4±8.0
昼-夜异常收缩压下降[例（%）]	68（75.6）
昼-夜舒张压下降率（%， $x ¯$ ±s）	6.0±8.3
昼-夜异常舒张压下降（%， $x ¯$ ±s）	63（70.0）
显著脑白质病变[例（%）]	34（37.8）

项目	轻度脑白质病变（n=56）	显著脑白质病变（n=34）	统计值	P值
年龄（岁， $x ¯$ ±s）	61.7±11.5	73.6±8.1	t=-5.20	0.000
女性[例（%）]	17（30.4）	9（26.5）	χ²=0.15	0.693
高血压病史[例（%）]	39（69.6）	28（82.4）	χ²=0.79	0.180
糖尿病病史[例（%）]	18（32.1）	12（35.3）	χ²=0.09	0.758
高脂血症病史[例（%）]	32（57.1）	16（47.1）	χ²=0.86	0.350
肾功能不全病史[例（%）]	3（5.4）	5（14.7）	χ²=2.28	0.130
脑血管病家族史[例（%）]	16（28.6）	4（11.8）	χ²=3.46	0.063
高同型半胱氨酸血症病史[例（%）]	27（48.2）	13（38.2）	χ²=0.85	0.356
心房颤动病史[例（%）]	1（1.8）	5（14.7）	-	0.027
吸烟史[例（%）]	30（53.6）	14（41.2）	χ²=0.30	0.254
饮酒史[例（%）]	16（28.6）	5（14.7）	χ²=2.27	0.132
在院血压收缩压（mmHg， $x ¯$ ±s）	142.0±16.4	142.3±11.1	t=-0.11	0.914
日-日血压标准差（mmHg， $x ¯$ ±s）	9.0±.4.0	9.5±4.5	t=-0.56	0.577
日-日血压变异系数（%， $x ¯$ ±s）	6.3±2.7	6.8±3.4	t=-0.67	0.504
昼-夜收缩压下降率（%， $x ¯$ ±s）	4.6±7.1	1.2±9.1	χ²=1.96	0.053
异常昼-夜收缩压下降[例（%）]	40（71.4）	28（82.4）	χ²=1.36	0.242
昼-夜舒张压下降率（%， $x ¯$ ±s）	7.6±7.9	3.3±8.5	t=2.40	0.019
异常昼-夜舒张压下降[例（%）]	35（62.5）	28（82.4）	χ²=3.97	0.046

项目	轻度脑白质病变（n=56）	显著脑白质病变（n=34）	统计值	P值
年龄（岁， $x ¯$ ±s）	61.7±11.5	73.6±8.1	t=-5.20	0.000
女性[例（%）]	17（30.4）	9（26.5）	χ²=0.15	0.693
高血压病史[例（%）]	39（69.6）	28（82.4）	χ²=0.79	0.180
糖尿病病史[例（%）]	18（32.1）	12（35.3）	χ²=0.09	0.758
高脂血症病史[例（%）]	32（57.1）	16（47.1）	χ²=0.86	0.350
肾功能不全病史[例（%）]	3（5.4）	5（14.7）	χ²=2.28	0.130
脑血管病家族史[例（%）]	16（28.6）	4（11.8）	χ²=3.46	0.063
高同型半胱氨酸血症病史[例（%）]	27（48.2）	13（38.2）	χ²=0.85	0.356
心房颤动病史[例（%）]	1（1.8）	5（14.7）	-	0.027
吸烟史[例（%）]	30（53.6）	14（41.2）	χ²=0.30	0.254
饮酒史[例（%）]	16（28.6）	5（14.7）	χ²=2.27	0.132
在院血压收缩压（mmHg， $x ¯$ ±s）	142.0±16.4	142.3±11.1	t=-0.11	0.914
日-日血压标准差（mmHg， $x ¯$ ±s）	9.0±.4.0	9.5±4.5	t=-0.56	0.577
日-日血压变异系数（%， $x ¯$ ±s）	6.3±2.7	6.8±3.4	t=-0.67	0.504
昼-夜收缩压下降率（%， $x ¯$ ±s）	4.6±7.1	1.2±9.1	χ²=1.96	0.053
异常昼-夜收缩压下降[例（%）]	40（71.4）	28（82.4）	χ²=1.36	0.242
昼-夜舒张压下降率（%， $x ¯$ ±s）	7.6±7.9	3.3±8.5	t=2.40	0.019
异常昼-夜舒张压下降[例（%）]	35（62.5）	28（82.4）	χ²=3.97	0.046

项目	Β值	OR值	95%CI	P值
年龄	-0.120	0.887	0.829~0.949	＜0.001
高血压病史	0.423	1.527	0.404~5.770	0.532
肾功能不全病史	1.031	2.803	0.416~18.900	0.290
心房颤动病史	0.529	1.697	0.142~20.296	0.676
脑血管病家族史	-1.104	0.332	0.077~1.430	0.139
饮酒史	-0.278	0.758	0.196~2.928	0.687
异常昼-夜舒张压下降	-1.514	0.220	0.065~0.806	0.022

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