Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA.
Curr Hypertens Rep. 2018 Apr 10;20(4):28. doi: 10.1007/s11906-018-0827-5.
Elevations in systolic blood pressure (BP) greater than 140 mmHg are reported in the majority (75%) of patients with acute ischemic stroke and in 80% of patients with acute intracerebral hemorrhages (ICH). This paper summarizes and updates the current knowledge regarding the proper management strategy for elevated BP in patients with acute stroke. Recent studies have generally showed a neutral effect of BP reduction on clinical outcomes among acute ischemic stroke patients. Thus, because of the lack of convincing evidence from clinical trials, aggressive BP reduction in patients presenting with acute ischemic stroke is currently not recommended. Although in patients treated with intravenous tissue plasminogen activator, guidelines are recommending BP < 180/105 mmHg but currently, the optimal BP management after reperfusion therapy still remains unclear. In acute ICH, the evidence from randomized clinical trials supports the immediate BP lowering targeting systolic BP to 140 mmHg, which is now recommended by guidelines.
收缩压（BP）升高大于 140mmHg 见于大多数急性缺血性脑卒中患者（75%）和 80%急性脑出血（ICH）患者。本文总结和更新了目前关于急性脑卒中患者血压升高的适当管理策略的相关知识。最近的研究普遍表明，急性缺血性脑卒中患者的血压降低对临床结局没有影响。因此，由于临床试验缺乏令人信服的证据，目前不建议积极降低急性缺血性脑卒中患者的血压。虽然对于接受静脉内组织型纤溶酶原激活剂治疗的患者，指南建议血压<180/105mmHg，但目前再灌注治疗后最佳血压管理仍不清楚。急性 ICH 随机临床试验的证据支持立即降低血压，目标收缩压为 140mmHg，目前指南推荐这样做。
