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尽管治疗高血压在预防首发或复发性卒中中的作用不容置疑,但对卒中后最初数小时或数天内的高血压管理仍存在争论。80%的卒中患者在发病后数天内有血压升高,尚缺乏来自随机对照试验的高质量证据指导其治疗。理论上,对卒中发病后的血压管理有正反两方面的争论意见。大多数治疗指南建议根据病理生理学原理不对血压进行处理。但是,对随机试验的事后分析提示血压升高与复发性卒中和高病死率有关,即使在校正混杂因素后亦如此。另一方面,初步研究表明,经过选择的患者亚组人为地升高血压可能是有益的。在本综述中,我们对有关这一课题的最新研究做一概括。
Although the role of treatment of hypertension in the prevention of first-episode or recurrent stroke is undeniable, controversy remains about hypertension management within the first hours or days following stroke. Eighty percent of stroke patients have elevated blood pressure within days after onset and there is a lack of high quality evidence from randomized controlled trials to guide their treatment. In theory, blood pressure management after the onset of stroke has both positive and negative arguments. Most treatment guidelines suggest that blood pressure should not be treated according to the pathophysiology. However, an after-trial analysis of randomized trials suggests that elevated blood pressure is associated with recurrent stroke and high case fatality rates, even after the confounders have been corrected. On the other hand, preliminary studies have shown that it may be beneficial to artificially raise blood pressure in selected patient subgroups. In this review, we summarize the most recent research on this topic.