Prospects for the prevention of stroke
Prospects for the prevention of stroke
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DOI：
10.1097/01.hjh.0000220097.04531.6f
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发表时间：
2006-04-01
影响因子：
4.9
通讯作者：
Dahlöf, Björn
中科院分区：
文献类型：
--
作者：
Dahlöf, Björn
我们目前正在与中风疫情作斗争。实施新的治疗策略可以挽救未来许多患者的生命。控制血压是一个主要目标；然而，选择特定的降压治疗(例如，阻断肾素-血管紧张素系统的药物)也很重要，洛沙坦干预降低高血压终点(LIFE)研究表明，与更成熟的治疗方法相比，开出血管紧张素11受体阻滞剂(ARB)治疗左心室肥厚(LVH)患者不仅可以降低血压，而且还有潜在的好处。与阿替洛尔治疗相比，使用氯沙坦的治疗带来了左室肥厚的消退，致命性和非致命性中风的发生率降低了25%，新发糖尿病的发生率降低了25%，房颤的发生率降低了30%，血压控制相似，耐受性更好。这项关于老年人认知和预后的研究(SCOPE)研究，尽管难以解释，但并不与ARB在一级预防中的降压益处相矛盾，这与靶向血管紧张素1型受体有关。卒中后，依普沙坦与尼群地平在二级预防(MISH)试验中的发病率和死亡率比较的结果表明，在卒中二级预防中，明显的ARB益处不依赖于降压。实验结果和其他临床证据进一步支持ARB在预防中风方面的好处。替米沙坦是一种ARB，具有治疗中风的特别有趣的特征；鉴于其24小时的疗效，在临床剂量下对晨间血压激增和过氧化物酶体增殖物激活的受体-伽马活性具有更明显的保护作用。替米沙坦用于二级卒中预防的独特性能正在有效避免二次卒中预防方案(PROCESS)研究中进行测试。
We are currently fighting a battle against a stroke epidemic. Implementation of new treatment strategies could save many patients in the future. The control of blood pressure is a major objective; however, choosing specific antihypertensive therapy (e.g. an agent blocking the renin-angiotensin system) is also important, The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study demonstrates potential benefits beyond blood pressure reduction of prescribing an angiotensin 11 receptor blocker (ARB) compared with more established therapy in patients with left ventricular hypertrophy (LVH). Losartan-based therapy brought about regression of LVH and reduced incidences of fatal and non-fatal stroke by 25%, new-onset diabetes by 25% and atrial fibrillation by 30% more than atenolol-based therapy for a similar blood pressure control and better tolerability. The Study on COgnition and Prognosis in the Elderly (SCOPE) study, although difficult to interpret, does not contradict an ARB benefit beyond blood pressure lowering in primary prevention linked to targeting the angiotensin type 1 receptor. The findings of the MOrbidity and mortality after Stroke, Eprosartan compared with nitrendipine in Secondary prevention (MOSES) trial suggest clear-cut ARB benefits independent of blood pressure lowering in secondary stroke prevention. Experimental findings and other clinical evidence further support the benefits of ARBs in stroke prevention. Telmisartan is an ARB with a particularly interesting profile for stroke; given the 24-hour efficacy with more pronounced protection against the morning blood pressure surge and peroxisome proliferator-activated receptor-gamma activity at clinical doses. The unique properties of telmisartan for secondary stroke prevention are being tested in the Prevention Regimen For Effectively avoiding Second Strokes (PRoFESS) study.