Hypertension:卒中前接受降压治疗的患者发生急性脑卒中是继续还是暂停降压治疗?

2017-03-09 xing.T MedSci原创

因此,在卒中前接受抗高血压药物治疗的患者中,卒中后的最初几个小时或几天内没有必要紧急进行原有的降压治疗,除非存在有指征的其他合并症。

超过50%的急性脑卒中患者在住院时就已经接受了抗高血压药物治疗。近日,心血管权威杂志Hypertension上发表了一篇荟萃分析文章,研究人员对随机对照试验的个体患者数据进行荟萃分析,以确定持续与暂时停止现有的抗高血压药物治疗对急性脑卒中的影响。

研究人员对关键数据库进行了检索,按照以下纳入标准检索试验:随机化设计;脑卒中发病≤48小时;调查了持续与暂时停止卒中前的抗高血压药物治疗的疗效;随访时间≥2周。

研究人员确定了两个随机对照试验,在这项分析个体患者数据的荟萃分析中共纳入了2860例脑卒中发病≤48小时的急性脑卒中患者。每个研究的偏倚风险较低,在调整后的Logistic回归模型和多元回归分析(使用随机效应)中,研究人员发现脑卒中前持续抗高血压治疗(相比于暂时停药)与随访最终的死亡或依赖风险没有显著相关性:比值比为0.96(95%可信区间为0.80-1.14)。在随访结束后,脑卒中前持续抗高血压治疗(相比于暂时停药)与研究次要结局之间没有显著相关性。在预先设定的亚组中进行的死亡和依赖性分析显示持续治疗和暂时停止治疗之间无显著相关性,除非患者发病≤12小时进行随机化,其中暂时停止治疗的差异具有统计学意义。研究人员没有发现在急性卒中期持续抗高血压治疗有显著的好处。

因此,在卒中前接受抗高血压药物治疗的患者中,卒中后的最初几个小时或几天内没有必要紧急进行原有的降压治疗,除非存在有指征的其他合并症。

原始出处:

Lisa J. Woodhouse, et al. Continuing or Temporarily Stopping Prestroke Antihypertensive Medication in Acute Stroke An Individual Patient Data Meta-Analysis
.Hypertension. 2017.https://doi.org/10.1161/HYPERTENSIONAHA.116.07982

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    2017-09-13 feather89
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    2017-03-10 baihao215

    嗯,还是观望的多

    0