Heitsch Laura, Jauch Edward C
Department of Emergency Medicine, Greater Cincinnati/Northern Kentucky Stroke Team, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA.
Curr Hypertens Rep. 2007 Dec;9(6):506-11. doi: 10.1007/s11906-007-0092-5.
The optimal management of blood pressure in the first 24 hours of ischemic stroke remains a controversial topic. Most patients are hypertensive at presentation and subsequently experience a spontaneous decline in blood pressure. Decreasing penumbral blood flow and exacerbating vasogenic edema are significant concerns in whether to treat blood pressure elevations. Although an initially elevated blood pressure has been associated with poor outcome, attempts to acutely lower blood pressure are also associated with worsened outcomes. Thus, the current approach in acute ischemic stroke is permissive hypertension, in which antihypertensive treatment is warranted in patients with systolic blood pressure greater than 220 mm Hg, receiving thrombolytic therapy, or with concomitant medical issues. The use of predictable and titratable medications that judiciously reduce (approximately 10% to 15%) the initial presenting mean arterial pressure is recommended in these situations. Future study must define optimal blood pressure goals, likely on an individual basis.
缺血性卒中发病后最初24小时内的血压最佳管理仍是一个有争议的话题。大多数患者就诊时血压升高，随后血压会自发下降。在是否治疗血压升高方面，降低半暗带血流量和加重血管源性水肿是重大顾虑。虽然最初血压升高与预后不良相关，但急性降低血压的尝试也与预后恶化有关。因此，目前急性缺血性卒中的治疗方法是允许性高血压，即收缩压大于220 mmHg、接受溶栓治疗或伴有其他内科问题的患者需要进行降压治疗。在这些情况下，建议使用可预测且可滴定的药物，谨慎降低（约10%至15%）初始就诊时的平均动脉压。未来的研究必须确定最佳血压目标，可能需要根据个体情况而定。
