Goldstein L B
Duke Center for Cerebrovascular Disease, Stroke Policy Program, Duke University, North Carolina 27710, USA.
Drug Saf. 2000 Jan;22(1):13-8. doi: 10.2165/00002018-200022010-00002.
Hypertension is a major risk factor for stroke and many patients with acute stroke have elevated blood pressures. The management of hypertension in the setting of acute ischaemic stroke remains a source of confusion and controversy. Lowering blood pressure in this setting may be hazardous because of impaired cerebral autoregulation. Treatment may be considered in patients who are otherwise candidates for thrombolytic therapy, patients who have severe hypertension or patients who have specific concomitant medical conditions including acute myocardial infarction, aortic dissection, hypertensive encephalopathy, or severe left ventricular failure. In choosing an agent for acute treatment, drugs that can produce a precipitous decline in blood pressure (e.g. sublingual calcium antagonists) should be avoided. Drugs with the capacity to dilate cerebral vessels should be used with caution as they have the potential to increase intracranial pressure. Long term management of hypertension in poststroke patients is often required. The potential for certain classes of drugs (e.g. alpha2-adrenergic receptor agonists and alpha1-adrenergic receptor antagonists) to impair the recovery process should be considered when choosing an antihypertensive for treatment of these patients.
高血压是中风的主要危险因素，许多急性中风患者血压升高。急性缺血性中风时高血压的管理仍然是一个令人困惑和有争议的问题。在这种情况下降低血压可能是危险的，因为脑自动调节功能受损。对于那些适合溶栓治疗的患者、患有严重高血压的患者或患有特定伴随疾病（包括急性心肌梗死、主动脉夹层、高血压脑病或严重左心室衰竭）的患者，可以考虑进行治疗。在选择急性治疗药物时，应避免使用能使血压急剧下降的药物（如舌下含服钙拮抗剂）。具有扩张脑血管能力的药物应谨慎使用，因为它们有可能增加颅内压。中风后患者通常需要长期管理高血压。在为这些患者选择抗高血压药物时，应考虑某些类别的药物（如α2肾上腺素能受体激动剂和α1肾上腺素能受体拮抗剂）损害恢复过程的可能性。
