Simonenko V B, Shirokov E A, Ovchinnikov Iu V
Klin Med (Mosk). 2006;84(11):4-9.
Lethality associated with secondary cerebral stroke is higher than in primary one. Data on the clinical course of arterial hypertension after stroke are contradictory. In recent years, the risk of a repeated ischemic stroke has been considered to be in a direct correlation with both systolic and diastolic blood pressure (BP), while the optimal BP level differs depending on the type of the stroke. Lowering BP should not exceed the ability of brain flow autoregulation to maintain normal cerebral perfusion. Data on the effectiveness of different groups of antihypertensive drugs in terms of secondary stroke prevention are contradictory. It has been reported that the risk of a secondary cerebral stroke lowered depending on the degree of BP decrease. At the same time, various antihypertensive drug classes were directly compared only in MOSES study. As far as secondary stroke prevention is concerned, differences between these classes suggest the existence of other than hypotensive mechanisms of their action. The presence of carotid atherosclerosis may compromise cerebral perfusion and predispose the patient to a second stroke, when a hypotensive effect is achieved.
与继发性脑卒相关的致死率高于原发性脑卒。关于脑卒中后动脉高血压临床病程的数据相互矛盾。近年来，复发性缺血性脑卒中的风险被认为与收缩压和舒张压均直接相关，而最佳血压水平因脑卒中类型而异。降低血压不应超过脑血流自动调节维持正常脑灌注的能力。关于不同类别降压药物在预防继发性脑卒中方面的有效性的数据相互矛盾。据报道，继发性脑卒的风险随血压降低程度而降低。同时，仅在MOSES研究中对各类降压药物进行了直接比较。就预防继发性脑卒中而言，这些类别之间的差异表明其作用机制除降压机制外还有其他机制。当出现降压效果时，颈动脉粥样硬化的存在可能会损害脑灌注并使患者易患第二次脑卒中。
