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血压管理在卒中预防中的作用:现状与展望。

The role of blood pressure management in stroke prevention: current status and future prospects.

机构信息

Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.

出版信息

Expert Rev Cardiovasc Ther. 2022 Oct;20(10):829-838. doi: 10.1080/14779072.2022.2137490. Epub 2022 Oct 27.

Abstract

INTRODUCTION

Stroke is the second-leading cause of death worldwide and the second-leading cause of disability-adjusted life-years. It is well known that hypertension is a significant risk factor for cardiovascular events, including stroke.

AREAS COVERED

Recent interventional trials have demonstrated the superiority of intensive blood pressure (BP) control for prevention of cardiovascular events compared to standard BP control. Notably, in the Strategy of Blood Pressure Intervention in Elderly Hypertensive Patients (STEP) trial, intensive BP control showed superiority in the prevention of stroke events in elderly hypertensive patients. Novel medications such as angiotensin receptor-neprilysin inhibitors and sodium glucose cotransporter 2 inhibitors have the potential to suppress various CVD events including stroke. Non-pharmacological antihypertensive therapies such as renal denervation have demonstrated BP-lowering effects and may be useful for stroke prevention. Additionally, new methods and systems of BP monitoring including various kinds of nighttime BP measurement devices, wearable devices, and methods using information and communication technology can be used to assess the pathophysiology of BP variability as a risk factor and an event trigger of stroke incidence.

EXPERT OPINION

Novel therapies and new technologies for BP evaluation strongly support the development of individualized anticipatory medicine, which should be useful for the prevention of stroke.

摘要

简介

中风是全球第二大致死原因,也是导致伤残调整生命年(DALY)的第二大原因。众所周知,高血压是心血管事件(包括中风)的一个重要危险因素。

涵盖领域

最近的介入性试验表明,与标准血压控制相比,强化血压(BP)控制更能预防心血管事件。值得注意的是,在老年高血压患者血压干预策略(STEP)试验中,强化 BP 控制在预防老年高血压患者中风事件方面显示出优越性。血管紧张素受体-脑啡肽酶抑制剂和钠-葡萄糖共转运蛋白 2 抑制剂等新型药物有可能抑制包括中风在内的各种心血管疾病事件。肾去神经等非药物降压疗法已显示出降压效果,可能有助于预防中风。此外,新的血压监测方法和系统,包括各种夜间血压测量设备、可穿戴设备以及使用信息和通信技术的方法,可用于评估血压变异性作为中风发病率的风险因素和事件触发因素的病理生理学。

专家意见

新型降压治疗策略和新技术强烈支持个体化预测医学的发展,这对于中风的预防可能是有用的。

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