Wityk Robert J, Lewin John J
Cerebrovascular Division, The Johns Hopkins Hospital, Phipps 126 B, Baltimore, MD 21287, USA.
Expert Opin Pharmacother. 2006 Feb;7(3):247-58. doi: 10.1517/14656566.7.3.247.
Control of hypertension is a well-established goal of primary stroke prevention. Management of blood pressure in patients during acute ischaemic stroke, however, is complicated by the need to maintain brain perfusion. Lowering blood pressure in the acute setting may avoid the deleterious effects of high blood pressure but may also lead to cerebral hypoperfusion and worsening of the ischaemic stroke. Little information is available from clinical trials concerning optimal blood pressure management in acute stroke. Current protocols of thrombolytic therapy require strict blood pressure control below certain prescribed limits; however, in most acute stroke patients not treated with thrombolysis, blood pressure reduction is not routinely recommended and guidelines for target blood pressures are difficult to justify. Preliminary studies, in fact, suggest that there may be a role for blood pressure elevation in the treatment of some patients with acute ischaemic stroke.
控制高血压是一级卒中预防的既定目标。然而，在急性缺血性卒中患者中进行血压管理时，由于需要维持脑灌注，情况变得复杂。在急性情况下降低血压可能避免高血压的有害影响，但也可能导致脑灌注不足和缺血性卒中恶化。关于急性卒中最佳血压管理的临床试验提供的信息很少。目前的溶栓治疗方案要求将血压严格控制在规定的特定限度以下；然而，在大多数未接受溶栓治疗的急性卒中患者中，通常不建议降低血压，而且很难为目标血压指南提供合理依据。事实上，初步研究表明，血压升高在治疗一些急性缺血性卒中患者中可能起作用。
