Wityk Robert J
From the Department of Neurology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
Neurologist. 2007 Jul;13(4):171-81. doi: 10.1097/NRL.0b013e318068b63e.
Control of hypertension is a well-established goal of primary prevention of stroke, but management of blood pressure in patients with a previous stroke or in the setting of acute stroke is complicated by the effect blood pressure changes may have on cerebral perfusion.
For patients with previous transient ischemic attack or chronic stroke, blood pressure reduction appears to be a safe and important facet of the secondary prevention of recurrent stroke. Less information is available concerning blood pressure management in acute stroke. Current protocols require strict blood pressure control in patients who are treated with thrombolytic therapy, to reduce the risk of hemorrhagic complications. In patients presenting with acute intracerebral hemorrhage, blood pressure reduction does not appear to cause significant reduction of cerebral blood flow, but at this time there are no studies to determine if there is a clinical benefit of acute blood pressure reduction in these patients. Finally, blood pressure reduction is not routinely recommended in patients with acute ischemic stroke, as it may precipitate further cerebral ischemia. Preliminary studies suggest, in fact, that there may be a role in the future for blood pressure elevation in the treatment of patients with acute ischemic stroke.
Current data support the use of blood pressure reduction in the secondary prevention of stroke in patients with cerebrovascular disease. In the setting of acute stroke, however, data are limited and blood pressure management must be tailored to the specific clinical situation.
控制高血压是预防中风一级预防的既定目标，但既往有中风病史或急性中风患者的血压管理因血压变化对脑灌注的影响而变得复杂。
对于既往有短暂性脑缺血发作或慢性中风的患者，降低血压似乎是预防复发性中风二级预防的一个安全且重要的方面。关于急性中风时血压管理的信息较少。目前的方案要求对接受溶栓治疗的患者进行严格的血压控制，以降低出血性并发症的风险。在急性脑出血患者中，降低血压似乎不会导致脑血流量显著减少，但目前尚无研究确定这些患者急性降低血压是否具有临床益处。最后，急性缺血性中风患者不常规推荐降低血压，因为这可能会引发进一步的脑缺血。事实上，初步研究表明，未来升高血压在治疗急性缺血性中风患者中可能会发挥作用。
目前的数据支持在脑血管疾病患者中风二级预防中使用降低血压的方法。然而，在急性中风的情况下，数据有限，血压管理必须根据具体临床情况进行调整。
