Wijdicks E F, Vermeulen M, Murray G D, Hijdra A, van Gijn J
Dept. of Neurology, University Hospital Dijkzigt, Rotterdam.
Clin Neurol Neurosurg. 1990;92(2):111-7. doi: 10.1016/0303-8467(90)90085-j.
We investigated in a consecutive series of 134 patients with aneurysmal subarachnoid hemorrhage whether institution of antihypertensive treatment was related to the incidence of cerebral ischemia and rebleeding. The aim of hypertensive treatment was to reduce the diastolic blood pressure to levels below 100 mm Hg. There was no difference in outcome between patients with or without antihypertensive drugs. Rebleeding was less frequent in patients with antihypertensive treatment (12/80 patients (15%) versus 18/54 patients (33%) without anti-hypertensive treatment (p = 0.012)). Nevertheless, patients with anti-hypertensive treatment had, on average, still higher blood pressures than untreated patients. Conversely, infarction occurred more often in patients with anti-hypertensive treatment (34/80 patients (43%) versus 12/54 (22%) without antihypertensives (p = 0.03)). This relationship was partly explained by co-existing hyponatremia. Our results suggest that the need for antihypertensive treatment is questionable, since the prevention of rebleeding is offset by an increased risk of cerebral infarction.
我们对连续收治的134例动脉瘤性蛛网膜下腔出血患者进行了研究，以探讨降压治疗的实施是否与脑缺血和再出血的发生率相关。降压治疗的目的是将舒张压降至100 mmHg以下。使用或未使用降压药物的患者在预后方面没有差异。接受降压治疗的患者再出血的频率较低（80例患者中有12例（15%），未接受降压治疗的54例患者中有18例（33%），p = 0.012）。然而，接受降压治疗的患者平均血压仍高于未治疗的患者。相反，接受降压治疗的患者梗死发生率更高（80例患者中有34例（43%），未使用降压药的54例患者中有12例（22%），p = 0.03）。这种关系部分可由并存的低钠血症来解释。我们的结果表明，降压治疗的必要性值得怀疑，因为预防再出血被脑梗死风险增加所抵消。
