Kenton E J
Division of Neurology, Lankenau Hospital, Wynewood, Pennsylvania, USA.
J Natl Med Assoc. 1996 Jun;88(6):364-8.
There remains nearly a twofold increase in blacks compared with whites for stroke mortality. The death rate from cerebral hemorrhage in blacks approximates twice that of whites. Subarachnoid hemorrhage is a frequent cause of mortality and morbidity in stroke and is also about twice as frequent in blacks. Lacunar strokes occur more in blacks reflecting increased incidence of hypertension and are leading causes of multi-infarct encephalopathy and dementia. Therefore, the concomitant occurrence of hypertension and stroke is most common in African Americans and requires diagnosis of the type of stroke, which then defines the rationale of blood pressure control. Cerebral vascular changes associated with acute, chronic, and reactive hypertension are operative. When to treat, when not to treat, and the appropriateness of specific antihypertensive agents in acute stroke are relevant. A common misconception is that the increased blood pressure is the cause of the stroke when it is likely the result of the stroke. Lowering the blood pressure in all acute stroke patients with elevated blood pressure may worsen the neurologic deficit. Thus, the judicious control of blood pressure is to be stressed in the concomitant occurrence of hypertension and stroke.
与白人相比，黑人的中风死亡率几乎高出一倍。黑人脑出血的死亡率约为白人的两倍。蛛网膜下腔出血是中风致死和致残的常见原因，在黑人中出现的频率也约为白人的两倍。腔隙性中风在黑人中更为常见，这反映出高血压发病率的增加，并且是多发性脑梗死性脑病和痴呆的主要原因。因此，高血压和中风同时出现的情况在非裔美国人中最为常见，需要对中风类型进行诊断，进而确定血压控制的基本原理。与急性、慢性和反应性高血压相关的脑血管变化起作用。何时治疗、何时不治疗以及特定抗高血压药物在急性中风中的适用性都是相关问题。一个常见的误解是，血压升高是中风的原因，而实际上它很可能是中风的结果。在所有血压升高的急性中风患者中降低血压可能会使神经功能缺损恶化。因此，在高血压和中风同时出现的情况下，应强调明智地控制血压。
