McManus Michael, Liebeskind David S
Neurovascular Imaging Research Core & UCLA Stroke Center, University of California, Los Angeles, CA, USA.
J Clin Neurol. 2016 Apr;12(2):137-46. doi: 10.3988/jcn.2016.12.2.137. Epub 2016 Jan 28.
Hypertension is present in up to 84% of patients presenting with acute stroke, and a smaller proportion of patients have blood pressures that are below typical values in the context of cerebral ischemia. Outcomes are generally worse in those who present with either low or severely elevated blood pressure. Several studies have provided valuable information about malignant trends in blood pressure during the transition from the acute to the subacute phase of stroke. It is not uncommon for practitioners in clinical practice to identify what appear to be pressure-dependent neurologic deficits. Despite physiologic and clinical data suggesting the importance of blood pressure modulation to support cerebral blood flow to ischemic tissue, randomized controlled trials have not yielded robust evidence for this in acute ischemic stroke. We highlight previous studies involving acute-stroke patients that have defined trends in blood pressure and that have evaluated the safety and efficacy of blood-pressure modulation in acute ischemic stroke. This overview reports the current status of this topic from the perspective of a stroke neurologist and provides a framework for future research.
高达84%的急性中风患者存在高血压，且在脑缺血情况下，有较小比例患者的血压低于正常水平。血压过低或严重升高的患者预后通常较差。多项研究提供了有关中风从急性期过渡到亚急性期血压恶性变化趋势的宝贵信息。在临床实践中，从业者识别出似乎与血压相关的神经功能缺损并不罕见。尽管生理和临床数据表明调节血压以支持缺血组织的脑血流很重要，但随机对照试验尚未在急性缺血性中风中为此提供有力证据。我们重点介绍了以往涉及急性中风患者的研究，这些研究明确了血压变化趋势，并评估了急性缺血性中风中血压调节的安全性和有效性。本综述从中风神经科医生的角度报告了该主题的现状，并为未来研究提供了框架。
