Bertel O, Marx B E, Conen D
Am J Med. 1987 Mar 30;82(3B):29-36. doi: 10.1016/0002-9343(87)90208-7.
Antihypertensive treatment reduces the risk of ischemic strokes and cerebral hemorrhage as complications of excessive or long-standing hypertension. However, neurologic dysfunction and brain damage may also accompany short-term, and under certain conditions, even long-term antihypertensive treatment. Therefore, treatment should be instituted restrictively and cautiously. Special regard should be given to the action of antihypertensive drugs on cerebral perfusion in patients with an increased risk for the development of treatment-induced cerebral ischemic complications, such as patients with hypertensive encephalopathy or autonomic dysfunction, and elderly patients with suspected sclerotic stenosis of cerebral or neck arteries. The structural and functional lesions of cerebral vessels observed in acute and chronic hypertension are reviewed, as are the effects of antihypertensive drugs on cerebral blood flow. Calcium channel blockers and angiotensin-converting enzyme inhibitors may have advantages as first-line drugs in the treatment of patients with an elevated risk of cerebral hypoperfusion, because of the selective action of these agents on vasoconstricted vessels and their differential effects in varying regional vascular beds. The excellent efficacy of these drugs in the short- and long-term treatment of hypertension may lead to changes in the traditional management of hypertensive emergencies as well as in management strategies for other patients at risk for treatment-induced complications.
作为过度或长期高血压的并发症，抗高血压治疗可降低缺血性卒中和脑出血的风险。然而，短期乃至在某些情况下长期的抗高血压治疗也可能伴有神经功能障碍和脑损伤。因此，治疗应严格且谨慎地进行。对于发生治疗诱发的脑缺血并发症风险增加的患者，如患有高血压脑病或自主神经功能障碍的患者以及疑似脑或颈部动脉粥样硬化狭窄的老年患者，应特别关注抗高血压药物对脑灌注的作用。本文回顾了急性和慢性高血压中观察到的脑血管结构和功能病变，以及抗高血压药物对脑血流的影响。钙通道阻滞剂和血管紧张素转换酶抑制剂作为一线药物，在治疗脑灌注不足风险升高的患者时可能具有优势，因为这些药物对血管收缩的血管具有选择性作用，且在不同区域血管床有不同效果。这些药物在高血压短期和长期治疗中的卓越疗效可能会改变高血压急症的传统管理方式以及其他有治疗诱发并发症风险患者的管理策略。
