Späh F, Walsemann S O
Department of Internal Medicine I (Cardiology), City Hospital Krefeld, Germany.
Blood Press Suppl. 1995;3:62-7.
Stroke is a partly preventable neurological disease associated with excessive economic cost. Adequate prevention of stroke and sufficient therapy in the acute phase will help to reduce the heavy burden of morbidity and severe economic impact. Hypertension as such, and even more so stroke itself, are known to influence cerebral autoregulation in a negative sense. With respect to the prevention of stroke, antihypertensive therapy should be accompanied by attempts to inhibit of atherogenesis, for instance via improvements of the lipid profile (lowering of LDL, elevation of HDL) or via inhibition of platelet aggregation. In conditions of acute stroke, a pharmacologically induced rise in intracranial pressure should be avoided, whereas cerebral perfusion pressure must be maintained. If possible, ischaemic tolerance should be increased. Also with respect to the secondary prevention of stroke, antihypertensive therapy should be aiming at maintaining cerebral blood flow, whereas the progression of atherosclerotic lesions should be impaired as much as possible. Urapidil may be characterised as a peripheral alpha 1-adrenoceptor blocker with additional sympathoinhibitory effect, triggered by the stimulation of central 5HT1A-receptors. Urapidil, well documented as an effective antihypertensive agent in short- and long-term trials, also showed beneficial influence in the acute phase of stroke. After 3 years of treatment with urapidil (60 mg b.i.d.), the total cardiovascular risk proved reduced by 26%. In addition, urapidil influenced lipid profile, glucose metabolism, and platelet aggregation favourably in hypertensive patients. In animal experiments, urapidil improved the ischaemic tolerance of the brain. Taken together it would seem worthwhile to investigate urapidil as a possibly beneficial agent in the treatment of acute stroke, as well as in secondary prevention of this condition.
中风是一种部分可预防的神经疾病，会带来高昂的经济成本。充分预防中风并在急性期进行充分治疗，将有助于减轻发病的沉重负担和严重的经济影响。众所周知，高血压本身，尤其是中风本身，会对脑自动调节产生负面影响。在预防中风方面，抗高血压治疗应同时尝试抑制动脉粥样硬化的发生，例如通过改善血脂状况（降低低密度脂蛋白、提高高密度脂蛋白）或抑制血小板聚集。在急性中风的情况下，应避免药物性颅内压升高，同时必须维持脑灌注压。如果可能，应提高缺血耐受性。同样在中风的二级预防方面，抗高血压治疗应旨在维持脑血流量，同时尽可能抑制动脉粥样硬化病变的进展。乌拉地尔可被描述为一种外周α1肾上腺素能受体阻滞剂，具有额外的交感神经抑制作用，由中枢5HT1A受体的刺激引发。乌拉地尔在短期和长期试验中均被充分证明是一种有效的抗高血压药物，在中风急性期也显示出有益影响。用乌拉地尔（60毫克，每日两次）治疗3年后，总心血管风险降低了26%。此外，乌拉地尔对高血压患者的血脂状况、糖代谢和血小板聚集有有利影响。在动物实验中，乌拉地尔改善了大脑的缺血耐受性。综上所述，研究乌拉地尔作为治疗急性中风以及这种疾病二级预防中可能有益的药物似乎是值得的。
