Blood Pressure Goals in Acute Stroke.

Blood Pressure Goals in Acute Stroke.
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急性中风的血压目标。

DOI:
10.1093/ajh/hpac039
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发表时间:
2022-06-16
影响因子:
3.2
通讯作者:
--
中科院分区:
医学3区
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--
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抗高血压治疗对于中风的一级和二级预防均非常有效。然而,目前关于急性卒中血压目标的指南建议是临床经验性的并且通常是保守的。仅建议针对严重高血压进行抗高血压治疗。最近的几项观察性研究表明,血压与不良临床结果之间的关系在急性出血性中风中可能呈正相关,但在最低血压未确定的急性缺血性中风中呈 J 形或 U 形关系。随机对照试验的结果对于出血性中风的血压管理很有希望,但对于缺血性中风则不然。 140 毫米汞柱的收缩压目标可能适合急性出血性中风。然而,急性缺血性卒中的血压目标是不确定的,可能取决于治疗的时间窗和血运重建治疗的使用。需要进一步的研究来调查抗高血压治疗对急性中风的潜在益处,特别是在中风的急性期和亚急性期分别可能减少血压变异性和更强烈地降低血压。
Antihypertensive treatment is highly effective in both primary and secondary prevention of stroke. However, current guideline recommendations on the blood pressure goals in acute stroke are clinically empirical and generally conservative. Antihypertensive treatment is only recommended for severe hypertension. Several recent observational studies showed that the relationship between blood pressure and unfavorable clinical outcomes was probably positive in acute hemorrhagic stroke but J- or U-shaped in acute ischemic stroke with undetermined nadir blood pressure. The results of randomized controlled trials are promising for blood pressure management in hemorrhagic stroke but less so in ischemic stroke. A systolic blood pressure goal of 140 mm Hg is probably appropriate for acute hemorrhagic stroke. The blood pressure goal in acute ischemic stroke, however, is uncertain, and probably depends on the time window of treatment and the use of revascularization therapy. Further research is required to investigate the potential benefit of antihypertensive treatment in acute stroke, especially with regard to the possible reduction of blood pressure variability and more intensive blood pressure lowering in the acute and subacute phases of a stroke, respectively.
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