Stroke:急性卒中后启用降压治疗的时机和血压目标

2018-12-31 杨中华 脑血管病及重症文献导读

高血压是卒中复发的重要危险因素。因此,在卒中二级预防中降压药物扮演着重要作用。

高血压卒中复发的重要危险因素。因此,在卒中二级预防中降压药物扮演着重要作用。

2018年11月来自荷兰的Thomas P. Zonneveld等在 Stroke 上发表了他们的meta 分析结果,目的在于探讨卒中或 TIA 至少48h 后开始降压药物(blood pressure-lowering drugs,BPLD)治疗是否能够预防卒中复发、严重血管事件和痴呆。

 
共纳入了11项研究,38742例患者:8项研究比较了 BPLD 和无治疗(n = 35110),3项研究比较了不同收缩压目标(n = 3632)。从卒中发病到开始 BPLD 治疗的时间差异很大,介于2天到5天。BPLD 的集合风险比(pooled risk ratio):复发性卒中为0.81 (95% CI, 0.70–0.93; n= 35.110);严重血管事件为0.90 (95% CI, 0.78–1.04; n= 28.630);痴呆为0.88  (95% CI, 0.73–1.06; n= 6.671)。

下图森林图比较了 BPLD vs 安慰剂或无治疗对所有类型卒中复发的作用:
 

该 meta 分析主要观察到在使用 ACEI 和利尿剂亚组降低了卒中复发风险(I2 statistic for subgroup differences, 72.1%; P=0.006)。强化降压治疗的集合风险比:复发性卒中为0.80 (95% CI 0.63–1.00),严重血管事件为0.58 (95% CI, 0.23–1.46)。

最终作者认为这个结果支持卒中或 TIA 后至少48h使用 BPLD以降低卒中复发的风险。当前的证据主要来自于 ACEI 和利尿剂的临床试验。当前的证据尚无法提供卒中或 TIA 后最佳的血压目标,但是我们的确观察到强化降压治疗能够降低卒中复发和严重血管事件的风险。

原始出处:Thomas P. Zonneveld, Edo Richard, Mervyn D.I. Vergouwen, et al. Blood Pressure-Lowering Treatment After Subacute Stroke to Prevent Recurrent Stroke, Major Vascular Events, and Dementia. Stroke. 25 Sep 2018

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    2018-12-31 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

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