Division of Stroke Medicine, University of Nottingham, City Hospital Campus, Hucknall Road, Nottingham, Nottinghamshire, UK, NG5 1PB.
Cochrane Database Syst Rev. 2000(2):CD000039. doi: 10.1002/14651858.CD000039.
It is unclear whether hypertension should be treated after acute stroke, and some have hypothesised that blood pressure should be increased to improve cerebral perfusion.
The objective of this review was to assess the effect of lowering or elevating blood pressure in people with acute stroke, and the effect of different vasoactive drugs on blood pressure in acute stroke.
We searched the Cochrane Stroke Group trials register, the Ottawa Stroke Trials Registry (1994), Medline (from 1965), Embase (from 1981), ISI, and existing review articles. We contacted researchers in the field and pharmaceutical companies.
Randomised trials of interventions that aimed to alter blood pressure in patients within two weeks of acute ischaemic or haemorrhagic stroke.
Two reviewers independently applied the inclusion criteria and assessed trial quality. Two reviewers extracted the data.
Three trials involving 133 people were included. The trials tested the following vasodilators: nimodipine (66 people), nicardipine (five people), captopril (three people) and clonidine (two people). Oral calcium channel blockers (nimodipine, nicardipine) reduced systolic blood pressure (weighted mean difference 10.9mmHg, 95% confidence interval 2.0 to 19.7), diastolic blood pressure (weighted mean difference 9.5mmHg, 95% confidence interval 4.0 to 15.1) and heart rate (weighted mean difference 4.7 beats per minute, 95% confidence interval 0.2 to 9.2) at 48 hours. The greatest fall in blood pressure over the first 24 hours was shown in patients given the highest dose of nimodipine. The relationship between change in blood pressure and clinical outcome was not clear. There was not enough information to assess the effect of drugs other than calcium channel blockers. No studies of interventions to raise blood pressure were found.
REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate the effect of altering blood pressure after acute stroke. Although oral calcium channel blockers appear to reduce blood pressure following acute stroke, the balance of benefit and risk remains unclear.
急性卒中后是否应治疗高血压尚不清楚，一些人推测应提高血压以改善脑灌注。
本综述的目的是评估降低或升高急性卒中患者血压的效果，以及不同血管活性药物对急性卒中患者血压的影响。
我们检索了Cochrane卒中小组试验注册库、渥太华卒中试验注册库（1994年）、Medline（自1965年起）、Embase（自1981年起）、ISI以及现有的综述文章。我们联系了该领域的研究人员和制药公司。
旨在改变急性缺血性或出血性卒中患者两周内血压的干预措施的随机试验。
两名评价员独立应用纳入标准并评估试验质量。两名评价员提取数据。
纳入了三项涉及133人的试验。这些试验测试了以下血管扩张剂：尼莫地平（66人）、尼卡地平（5人）、卡托普利（3人）和可乐定（2人）。口服钙通道阻滞剂（尼莫地平、尼卡地平）在48小时时降低了收缩压（加权平均差10.9mmHg，95%置信区间2.0至19.7）、舒张压（加权平均差9.5mmHg，95%置信区间4.0至15.1）和心率（加权平均差每分钟4.7次搏动，95%置信区间0.2至9.2）。在给予最高剂量尼莫地平的患者中，血压在最初24小时内下降幅度最大。血压变化与临床结局之间的关系尚不清楚。没有足够的信息来评估钙通道阻滞剂以外药物的效果。未发现提高血压干预措施的研究。
没有足够的证据来评估急性卒中后改变血压的效果。虽然口服钙通道阻滞剂似乎在急性卒中后能降低血压，但益处和风险的平衡仍不清楚。
