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预防卒中的降压和降脂治疗:现状与未来

Antihypertensive and lipid lowering treatment in stroke prevention: current state and future.

作者信息

Piechowski-Jóźwiak Bartłomiej, Bogousslavsky Julien

机构信息

Department of Neurology, CHUV, Lausanne, Switzerland.

出版信息

Acta Neurol Belg. 2005 Jun;105(2):57-61.

Abstract

Diabetes mellitus, arterial hypertension, smoking are major stroke risk factors. The role of hypercholesterolemia in stroke has not been established yet. In patients with type 2 diabetes mellitus there is evidence that intensive glucose lowering therapy diminishes the risk of microvascular complications. In all patients with stroke or transient ischemic attack (TIA), blood pressure should be lowered irrespectively of the baseline level with either diuretics, angiotensin converting enzyme (ACE) inhibitors, beta-blockers, or calcium antagonists. The role of angiotensin II (AT2) receptor blockers has not been established so far. In general terms a global approach to management of patients with vascular risk factors should be developed. An extended follow-up of randomised trials on preventive therapy should be completed. Controlled trials comparing angiotensin receptor blockers with ACE inhibitors should be started. Further research may focus on the new lipid lowering agents, and on the comparison of single lipid lowering agent vs. combinations in stroke prevention. These efforts should help in finding the best vasoprotective strategy in stroke prevention.

摘要

糖尿病、动脉高血压、吸烟是主要的中风危险因素。高胆固醇血症在中风中的作用尚未确定。有证据表明,在2型糖尿病患者中,强化降糖治疗可降低微血管并发症的风险。对于所有中风或短暂性脑缺血发作(TIA)患者,无论基线水平如何,均应使用利尿剂、血管紧张素转换酶(ACE)抑制剂、β受体阻滞剂或钙拮抗剂降低血压。迄今为止,血管紧张素II(AT2)受体阻滞剂的作用尚未确定。一般而言,应制定针对血管危险因素患者的整体管理方法。应完成预防性治疗随机试验的延长随访。应启动比较血管紧张素受体阻滞剂与ACE抑制剂的对照试验。进一步的研究可能集中在新型降脂药物,以及在中风预防中单一降脂药物与联合用药的比较。这些努力应有助于找到中风预防中最佳的血管保护策略。

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