Servicio de Neurología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain.
Servicio de Neurología, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain.
Neurologia (Engl Ed). 2021 Jul-Aug;36(6):462-471. doi: 10.1016/j.nrleng.2020.04.023. Epub 2021 Apr 23.
To update the recommendations of the Spanish Society of Neurology on primary and secondary stroke prevention in patients with arterial hypertension.
We proposed several questions to identify practical issues for the management of blood pressure (BP) in stroke prevention, analysing the objectives of blood pressure control, which drugs are most appropriate in primary prevention, when antihypertensive treatment should be started after a stroke, what levels we should aim to achieve, and which drugs are most appropriate in secondary stroke prevention. We conducted a systematic review of the PubMed database and analysed the main clinical trials to address these questions and establish a series of recommendations.
In primary stroke prevention, antihypertensive treatment should be started in patients with BP levels > 140/90 mmHg, with a target BP of < 130/80 mmHg. In secondary stroke prevention, we recommend starting antihypertensive treatment after the acute phase (first 24 hours), with a target BP of < 130/80 mmHg. The use of angiotensin-II receptor antagonists or diuretics alone or in combination with angiotensin-converting enzyme inhibitors is preferable.
更新西班牙神经病学学会关于动脉高血压患者一级和二级卒中预防的建议。
我们提出了几个问题，以确定卒中预防中血压（BP）管理的实际问题，分析血压控制的目标，哪些药物最适合一级预防，在卒中后何时应开始降压治疗，我们应达到的水平，以及哪些药物最适合二级卒中预防。我们对 PubMed 数据库进行了系统评价，并分析了主要临床试验，以解决这些问题并制定一系列建议。
在一级卒中预防中，应在 BP 水平>140/90mmHg 的患者中开始降压治疗，目标 BP<130/80mmHg。在二级卒中预防中，我们建议在急性期（24 小时内）后开始降压治疗，目标 BP<130/80mmHg。单独使用血管紧张素Ⅱ受体拮抗剂或利尿剂，或与血管紧张素转换酶抑制剂联合使用更为可取。
