Department of Neurology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA (M.T.M.).
The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (C.S.A.).
Stroke. 2022 Jul;53(7):2142-2151. doi: 10.1161/STROKEAHA.121.036885. Epub 2022 Jun 3.
Blood pressure (BP) is the most important modifiable risk factor for intracerebral hemorrhage (ICH). Elevated BP is associated with an increased risk of ICH, worse outcome after ICH, and in survivors, higher risks of recurrent ICH, ischemic stroke, myocardial infarction, and cognitive impairment/dementia. As intensive BP control probably improves the chances of recovery from acute ICH, the early use of intravenous or oral medications to achieve a systolic BP goal of <140 mm Hg within the first few hours of presentation is reasonable for being applied in most patients. In the long-term, oral antihypertensive drugs should be titrated as soon as possible to achieve a goal BP <130/80 mm Hg and again in all ICH patients regardless of age, location, or presumed mechanism of ICH. The degree of sustained BP reduction, rather than the choice of BP-lowering agent(s), is the most important factor for optimizing risk reduction, with varying combinations of thiazide-type diuretics, long-acting calcium channel blockers, ACE (angiotensin-converting enzyme) inhibitors or angiotensin receptor blockers, being the mainstay of therapy. As most patients will require multiple BP-lowering agents, and physician inertia and poor adherence are major barriers to effective BP control, single-pill combination therapy should be considered as the choice of management where available. Increased population and clinician awareness, and innovations to solving patient, provider, and social factors, have much to offer for improving BP control after ICH and more broadly across high-risk groups. It is critical that all physicians, especially those managing ICH patients, emphasize the importance of BP control in their practice.
血压（BP）是脑出血（ICH）最重要的可改变危险因素。BP 升高与 ICH 风险增加、ICH 后预后恶化以及幸存者ICH、缺血性卒中和心肌梗死以及认知障碍/痴呆的复发风险增加相关。由于强化 BP 控制可能会增加急性 ICH 康复的机会，因此在大多数患者中，在发病后数小时内使用静脉或口服药物将收缩压目标降至<140mmHg 是合理的。在长期，应尽快调整口服降压药物以实现目标血压<130/80mmHg，并再次应用于所有 ICH 患者，无论年龄、ICH 部位或推测的 ICH 机制如何。持续降低 BP 的程度，而不是降压药物的选择，是优化风险降低的最重要因素，噻嗪类利尿剂、长效钙通道阻滞剂、ACE（血管紧张素转换酶）抑制剂或血管紧张素受体阻滞剂的不同组合是治疗的主要方法。由于大多数患者需要多种降压药物，医生的惯性和治疗的依从性差是有效 BP 控制的主要障碍，因此在有条件的情况下，应考虑使用单片复方制剂治疗。提高人群和临床医生的认识，以及解决患者、提供者和社会因素的创新措施，对于改善 ICH 后和更广泛的高危人群的 BP 控制有很大帮助。所有医生，特别是管理 ICH 患者的医生，都必须强调 BP 控制在其治疗中的重要性。
