Department of Cardiovascular Sciences, University of Leicester, The Glenfield Hospital, British Heart Foundation Cardiovascular Research Centre.
NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.
Curr Opin Neurol. 2018 Feb;31(1):8-13. doi: 10.1097/WCO.0000000000000508.
Blood pressure (BP) elevations above premorbid levels are observed in at least 60% of acute ischemic and hemorrhagic stroke patients, within the first 24 h of symptom onset. A number of potential causes have been hypothesized, and high BP may be associated with poor stroke outcome. This review discusses management strategies of high BP in acute stroke, in the context of current guidelines.
Excessive BP elevation can impact acute stroke therapeutic strategies, particularly in modifying intervention safety and efficacy. Currently, guidance on BP management in acute ischemic stroke and intracerebral hemorrhage (ICH) exists in a limited number of specific clinical presentations, including spontaneous ICH and continuing versus stopping preexisting antihypertensive therapy. However, ongoing clinical trials will further investigate the safety and efficacy of urgent BP-lowering therapy for other indications.
There are clear national and international guidelines on BP lowering for specific indications, as well as ongoing clinical trials aiming to address common clinical scenarios in which the evidence-base is lacking and uncertain. This is specifically in important stroke subgroups previously excluded from trials, patients requiring mechanical thrombectomy and nonvitamin K antagonist-associated ICH reversal.
在症状发作的 24 小时内，至少 60%的急性缺血性和出血性脑卒中患者的血压（BP）升高超过了发病前的水平。有许多假设的潜在原因，高血压可能与不良的卒中预后有关。本综述讨论了在目前指南的背景下，急性卒中的高血压管理策略。
血压升高过高可能会影响急性卒中的治疗策略，特别是在改变干预措施的安全性和疗效方面。目前，急性缺血性卒中和脑出血（ICH）的 BP 管理指南只针对特定的临床表现，包括自发性 ICH 和继续或停止预先存在的降压治疗。然而，正在进行的临床试验将进一步研究降压治疗对其他适应症的安全性和疗效。
针对特定适应症，有明确的国家和国际降压指南，以及正在进行的临床试验，旨在解决证据基础缺乏和不确定的常见临床情况。这对于以前被排除在试验之外的重要卒中亚组、需要机械取栓和非维生素 K 拮抗剂相关 ICH 逆转的患者尤为重要。
