Zanchetti Alberto, Liu Lisheng, Mancia Giuseppe, Parati Gianfranco, Grassi Guido, Stramba-Badiale Marco, Silani Vincenzo, Bilo Grzegorz, Corrao Giovanni, Zambon Antonella, Scotti Lorenza, Zhang Xinhua, Wang HayYan, Zhang Yuqing, Zhang Xuezhong, Guan Ting Rui, Berge Eivind, Redon Josep, Narkiewicz Krzysztof, Dominiczak Anna, Nilsson Peter, Viigimaa Margus, Laurent Stéphane, Agabiti-Rosei Enrico, Wu Zhaosu, Zhu Dingliang, Rodicio José Luis, Ruilope Luis Miguel, Martell-Claros Nieves, Pinto Fernando, Schmieder Roland E, Burnier Michel, Banach Maciej, Cifkova Renata, Farsang Csaba, Konradi Alexandra, Lazareva Irina, Sirenko Yuriy, Dorobantu Maria, Postadzhiyan Arman, Accetto Rok, Jelakovic Bojan, Lovic Dragan, Manolis Athanasios J, Stylianou Philippos, Erdine Serap, Dicker Dror, Wei Gangzhi, Xu Chengbin, Xie Hengge, Coca Antonio, O'Brien John, Ford Gary
aIstituto Auxologico Italiano bUniversità di Milano, Milan, Italy cFuWai Hospital and Cardiovascular Institute dBeijing Hypertension League Institute, Beijing, China eUniversità Milano-Bicocca fIRCCS Multimedica, Sesto San Giovanni, Milan, Italy gOslo University Hospital, Oslo, Norway hUniversity of Valencia, Madrid, Spain iMedical University of Gdansk, Gdansk, Poland jUniversity of Glasgow, Glasgow, UK kLund University, Scania University Hospital, Malmo, Sweden lTallinn University of Technology, Tallinn, Estonia mEuropean Hospital Georges Pompidou, Paris, France nUniversità di Brescia, Spedali Civili, Brescia, Italy oBeijing Anzhen Hospital, Beijing pShanghai Hypertension Institute, Shanghai, China qComplutense University rHospital 12 de Octubre sHospital Clínico San Carlos, Madrid, Spain tCentro Hospitalar de Entre o Douro e Vouga, E.P.E., Portugal uNephrology and Hypertension, University Hospital, Erlangen, Germany vUniversity Hospital of Lausanne, Lausanne, Switzerland wMedical University of Lodz, Lodz, Poland xCharles University Medical School I and Thomayer Hospital, Prague, Czech Republic ySt. Imre University Teaching Hospital, Budapest, Hungary zAlmazov Federal Heart, Blood and Endocrinology Center, St. Petersburg, Russia aaRSPC Cardiology, Minsk, Belarus abNSC 'Institute of Cardiology named after N.D. Strazhesko' of NAMS, Kiev, Ukraine acEmergency Hospital of Bucharest, Bucharest, Romania adUniversity Hospital Saint Anna, Sofia, Bulgaria aeDr Peter Drzai Hospital, Ljubljana, Slovenia afUniversity Hospital Center Zagreb, Zagreb, Croatia agClinic for Internal Medicine InterMedic, Nis, Serbia ahCardiology Department, Asklepeion General Hospital, Athens, Greece aiNicosia General Hospital, Nicosia, Cyprus ajIstanbul University Cerrahpaşa School of Medicine, Istanbul, Turkey akHasharon Hospital - Rabin Medical Center, Petach-Tikva, Israel alBeijing Xuanwu Hospital amSecond Affiliate Hospital, Beijing University anMilitary General Hospital, Beijing, China aoH
J Hypertens. 2014 Sep;32(9):1741-50. doi: 10.1097/HJH.0000000000000253.
It is well established by a large number of randomized controlled trials that lowering blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) by drugs are powerful means to reduce stroke incidence, but the optimal BP and LDL-C levels to be achieved are largely uncertain. Concerning BP targets, two hypotheses are being confronted: first, the lower the BP, the better the treatment outcome, and second, the hypothesis that too low BP values are accompanied by a lower benefit and even higher risk. It is also unknown whether BP lowering and LDL-C lowering have additive beneficial effects for the primary and secondary prevention of stroke, and whether these treatments can prevent cognitive decline after stroke.
A review of existing data from randomized controlled trials confirms that solid evidence on optimal BP and LDL-C targets is missing, possible interactions between BP and LDL-C lowering treatments have never been directly investigated, and evidence in favour of a beneficial effect of BP or LDL-C lowering on cognitive decline is, at best, very weak.
A new, large randomized controlled trial is needed to determine the optimal level of BP and LDL-C for the prevention of recurrent stroke and cognitive decline.
大量随机对照试验已充分证实，通过药物降低血压（BP）和低密度脂蛋白胆固醇（LDL-C）是降低中风发病率的有效手段，但有待实现的最佳血压和LDL-C水平在很大程度上尚不确定。关于血压目标，存在两种相互矛盾的假设：其一，血压越低，治疗效果越好；其二，血压值过低会导致获益降低甚至风险升高。此外，降低血压和降低LDL-C对中风的一级和二级预防是否具有叠加的有益效果，以及这些治疗能否预防中风后的认知衰退，目前也尚不清楚。
对随机对照试验现有数据的回顾证实，缺乏关于最佳血压和LDL-C目标的确凿证据，从未直接研究过降低血压和降低LDL-C治疗之间可能的相互作用，而且支持降低血压或LDL-C对认知衰退有有益影响的证据充其量也非常薄弱。
需要开展一项新的大型随机对照试验，以确定预防复发性中风和认知衰退的最佳血压和LDL-C水平。
