High Blood Pressure in Acute Ischaemic Stroke - Broadening Therapeutic Horizons
High Blood Pressure in Acute Ischaemic Stroke - Broadening Therapeutic Horizons
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DOI：
10.1159/000200454
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发表时间：
2009-01-01
影响因子：
2.9
通讯作者：
Bath, Philip M. W.
中科院分区：
文献类型：
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作者：
Sare, Gillian M.;Geeganage, Chamila;Bath, Philip M. W.
80% 的急性缺血性中风患者患有高血压 (BP)，并且与不良预后独立相关。尽管这种流行病学表明应该急剧降低血压，但对大脑自动调节功能失调的担忧却表明事实并非如此。几项小型随机试验评估了各种抗高血压药物和药物在急性缺血性中风中的脑血流量。总体而言，这些研究表明脑灌注没有变化，尽管研究数量和患者数量有限，并且一些试验存在方法学问题。目前尚无大型已发表的随机试验评估急性卒中血压降低的结果。钙通道阻滞剂不会改变缺血性中风后的结果（29 项试验，7,665 名患者）。然而，一些试验，特别是那些测试静脉内钙通道阻滞剂（INWEST）或口服β受体拮抗剂（BEST）的试验报告了真实或潜在的危险。相比之下，口服坎地沙坦减少了 339 名缺血性中风患者 (ACCESS) 的复合血管事件，尽管它对残疾没有影响。 CHHIPS 试验发现，与安慰剂相比，随机接受积极治疗（拉贝洛尔、赖诺普利）的患者死亡率降低。两项大型试验报告称，葡萄糖钾-胰岛素疗法 (GIST) 或镁 (IMAGES) 可以降低血压，但对功能结果没有影响。 INTERACT 试点试验研究了脑出血患者，发现强化降压方案并未显着减少血肿扩张。有四项正在进行的大型试验正在研究是否继续或停止中风前抗高血压治疗（COSSACS、ENOS）或在急性中风（ENOS、SCAST）或出血时降低血压（INTERACT 2）。版权所有 (C) 2009 S. Karger AG，巴塞尔
High blood pressure (BP) is present in 80% of patients with acute ischaemic stroke and is independently associated with poor outcome. Although this epidemiology suggests that BP should be lowered acutely, concerns about dysfunctional cerebral autoregulation suggest otherwise. Several small randomised trials have assessed cerebral blood flow with various antihypertensive classes and agents in acute ischaemic stroke. Overall, these studies showed no change in cerebral perfusion, although the numbers of studies and patients are limited and there are methodological problems with some trials. There are no large published randomised trials assessing outcome with BP lowering in acute stroke. Calcium channel blockers did not alter outcome after ischaemic stroke (29 trials, 7,665 patients). However, some trials, especially those testing intravenous calcium channel blockers (INWEST) or oral beta-receptor antagonists (BEST) reported real or potential hazard. In contrast, oral candesartan reduced combined vascular events in 339 patients with ischaemic stroke (ACCESS) although it had no effect on disability. The CHHIPS trial found that death was reduced in patients randomised to active treatment (labetalol, lisinopril) as compared with placebo. Two larger trials reported that glucosepotassium-insulin therapy (GIST) or magnesium (IMAGES) lowered BP but had no effect on functional outcome. The INTERACT pilot trial studied patients with intracerebral haemorrhage and found that an intensive BP-lowering regime non-significantly reduced haematoma expansion. There are four large ongoing trials examining whether to continue or stop pre-stroke antihypertensive therapy (COSSACS, ENOS) or lower BP in acute stroke (ENOS, SCAST) or haemorrhage (INTERACT 2). Copyright (C) 2009 S. Karger AG, Basel