Division of Neurology, Department of Medicine, University of Alberta, AB, Canada.
Expert Rev Neurother. 2010 Feb;10(2):225-41. doi: 10.1586/ern.09.162.
Hypertension is the most prevalent of the modifiable risk factors for stroke. The benefits of blood pressure (BP) lowering on primary and secondary prevention of stroke are undeniable. Despite this, BP control in hypertensive individuals and patients with prior cerebrovascular events is suboptimal. Noncompliance, inappropriate antihypertensive usage and under-utilization of medications contribute significantly to inadequate BP control. Recently, elegantly designed studies that assessed the preventive role of BP lowering in patients with cerebrovascular disease have helped clarify management issues in terms of BP targets and effective antihypertensive regimens. Current evidence suggests that BP targets for primary and secondary prevention are suboptimal and need reassessment. The effect of BP modulation in acute stroke is still not completely understood. Although the thresholds for BP treatment in acute stroke have been recommended, BP targets are as yet ill-defined. The available evidence supports early lowering of blood pressure following stroke. This review discusses the impact of blood pressure on stroke incidence and outcomes, outlines the recommendations for blood pressure lowering in stroke and delineates questions that still need to be addressed.
高血压是中风可改变的风险因素中最常见的一种。降低血压(BP)对中风的一级和二级预防的益处是不可否认的。尽管如此,高血压患者和有过脑血管事件的患者的血压控制并不理想。不遵医嘱、降压药物使用不当和药物利用不足是导致血压控制不佳的主要原因。最近,一些设计精巧的研究评估了降压治疗在脑血管疾病患者中的预防作用,这有助于澄清血压目标和有效降压方案方面的管理问题。目前的证据表明,一级和二级预防的血压目标并不理想,需要重新评估。血压调节对急性中风的影响仍不完全清楚。尽管已经推荐了急性中风治疗的血压阈值,但血压目标仍未明确界定。现有的证据支持中风后早期降压。本文综述了血压对中风发病率和结局的影响,概述了中风降压治疗的建议,并指出了仍需要解决的问题。