Sandset Else Charlotte, Anderson Craig S, Bath Philip M, Christensen Hanne, Fischer Urs, Gąsecki Dariusz, Lal Avtar, Manning Lisa S, Sacco Simona, Steiner Thorsten, Tsivgoulis Georgios
Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway.
The Norwegian Air Ambulance Foundation, Oslo, Norway.
Eur Stroke J. 2021 Jun;6(2):II. doi: 10.1177/23969873211026998. Epub 2021 Jun 18.
The optimal blood pressure (BP) management in acute ischaemic stroke (AIS) and acute intracerebral haemorrhage (ICH) remains controversial. These European Stroke Organisation (ESO) guidelines provide evidence-based recommendations to assist physicians in their clinical decisions regarding BP management in acute stroke. The guidelines were developed according to the ESO standard operating procedure and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and made specific recommendations. Expert consensus statements were provided where insufficient evidence was available to provide recommendations based on the GRADE approach. Despite several large randomised-controlled clinical trials, quality of evidence is generally low due to inconsistent results of the effect of blood pressure lowering in AIS. We recommend early and modest blood pressure control (avoiding blood pressure levels >180/105 mm Hg) in AIS patients undergoing reperfusion therapies. There is more high-quality randomised evidence for BP lowering in acute ICH, where intensive blood pressure lowering is recommended rapidly after hospital presentation with the intent to improve recovery by reducing haematoma expansion. These guidelines provide further recommendations on blood pressure thresholds and for specific patient subgroups. There is ongoing uncertainty regarding the most appropriate blood pressure management in AIS and ICH. Future randomised-controlled clinical trials are needed to inform decision making on thresholds, timing and strategy of blood pressure lowering in different acute stroke patient subgroups.
急性缺血性卒中（AIS）和急性脑出血（ICH）的最佳血压管理仍存在争议。这些欧洲卒中组织（ESO）指南提供了基于证据的建议，以协助医生在急性卒中血压管理方面做出临床决策。该指南是根据ESO标准操作程序以及推荐分级、评估、制定和评价（GRADE）方法制定的。工作组确定了相关临床问题，对文献进行了系统评价和荟萃分析，评估了现有证据的质量，并提出了具体建议。在缺乏足够证据以基于GRADE方法提供建议的情况下，给出了专家共识声明。尽管有几项大型随机对照临床试验，但由于AIS中血压降低效果的结果不一致，证据质量总体较低。我们建议对接受再灌注治疗的AIS患者进行早期适度的血压控制（避免血压水平>180/105 mmHg）。在急性ICH中，有更多关于血压降低的高质量随机证据，建议在入院后迅速进行强化血压降低，以通过减少血肿扩大来改善恢复情况。这些指南提供了关于血压阈值和特定患者亚组的进一步建议。AIS和ICH中最合适的血压管理仍存在不确定性。未来需要进行随机对照临床试验，为不同急性卒中患者亚组的血压降低阈值、时机和策略的决策提供依据。
