Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Am J Hypertens. 2022 Jun 16;35(6):483-499. doi: 10.1093/ajh/hpac039.
Antihypertensive treatment is highly effective in both primary and secondary prevention of stroke. However, current guideline recommendations on the blood pressure goals in acute stroke are clinically empirical and generally conservative. Antihypertensive treatment is only recommended for severe hypertension. Several recent observational studies showed that the relationship between blood pressure and unfavorable clinical outcomes was probably positive in acute hemorrhagic stroke but J- or U-shaped in acute ischemic stroke with undetermined nadir blood pressure. The results of randomized controlled trials are promising for blood pressure management in hemorrhagic stroke but less so in ischemic stroke. A systolic blood pressure goal of 140 mm Hg is probably appropriate for acute hemorrhagic stroke. The blood pressure goal in acute ischemic stroke, however, is uncertain, and probably depends on the time window of treatment and the use of revascularization therapy. Further research is required to investigate the potential benefit of antihypertensive treatment in acute stroke, especially with regard to the possible reduction of blood pressure variability and more intensive blood pressure lowering in the acute and subacute phases of a stroke, respectively.
降压治疗在卒中和二级预防中均高度有效。然而，目前有关急性卒中国内指南中血压目标值的建议主要是临床经验性的，且通常较为保守。仅建议对严重高血压进行降压治疗。几项最近的观察性研究表明，在急性出血性卒中和未确定的最低血压的急性缺血性卒中中，血压与不良临床结局之间的关系可能呈正相关，呈 J 形或 U 形。随机对照试验的结果对脑出血患者的血压管理是有希望的，但对缺血性卒中的血压管理则不然。急性出血性卒中的收缩压目标可能为 140mmHg。然而，急性缺血性卒中的血压目标值尚不确定，可能取决于治疗的时间窗和再通治疗的使用。需要进一步研究以探讨降压治疗在急性卒中等方面的潜在获益，特别是在急性和亚急性期降低血压变异性和更强化降压治疗方面。
