Song Lili, Mao Yu, Sandset Else Charlotte, Kruyt Nyika D, Nederkoorn Paul J, Wang Xia, Gnanenthiran Sonali R, Anderson Craig S
Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China; The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.
Lancet Neurol. 2026 Feb;25(2):206-212. doi: 10.1016/S1474-4422(25)00378-3.
Patients with acute ischaemic stroke often present with elevated blood pressure. Evidence has emerged that challenges the longstanding recommendation across clinical guidelines that blood pressure should be controlled to a systolic pressure of less than 185 mm Hg before initiating reperfusion therapy in these patients. RECENT: developments Major clinical trials (INTERACT4, MR-ASAP, and RIGHT-2) and an observational study (TRUTH) indicate that intensively lowering blood pressure before initiating reperfusion therapy for acute ischaemic stroke is associated with increased risk of death and disability. Similar evidence has reshaped our approach to blood pressure management in patients who receive successful endovascular thrombectomy for acute ischaemic stroke from large-vessel occlusion. The underlying mechanisms of cerebral ischaemia are likely to involve alterations in cerebral blood flow through collateral vessels and the microcirculation. WHERE: next? Current evidence underscores the harms of more intensive lowering of blood pressure to a systolic target of less than 140 mm Hg both before and after reperfusion therapy for acute ischaemic stroke. Despite the challenges in obtaining the necessary randomised evidence, such efforts are now required to establish whether elevated blood pressure should be controlled at all with this disease or left to decrease naturally.
急性缺血性中风患者常常出现血压升高的情况。有证据表明，这对临床指南中长期以来的建议提出了挑战，该建议认为在对这些患者启动再灌注治疗之前，应将血压控制在收缩压低于185毫米汞柱。近期进展：主要临床试验（INTERACT4、MR - ASAP和RIGHT - 2）以及一项观察性研究（TRUTH）表明，在对急性缺血性中风启动再灌注治疗之前强化降低血压与死亡和残疾风险增加相关。类似的证据重塑了我们对因大血管闭塞而接受成功血管内血栓切除术的急性缺血性中风患者的血压管理方法。脑缺血的潜在机制可能涉及通过侧支血管和微循环的脑血流改变。下一步走向何方？目前的证据强调了在急性缺血性中风的再灌注治疗前后将血压强化降低至收缩压目标低于140毫米汞柱的危害。尽管获取必要的随机证据存在挑战，但现在需要做出此类努力，以确定对于这种疾病，血压升高是否根本就应得到控制，还是任其自然下降。
