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At the 7th Academic Annual Meeting of the Chinese Stroke Society and the Tiantan International Cerebrovascular Disease Conference (CSA & TISC 2021), Prof.
Sun Yongan from Peking University First Hospital gave an assessment of the blood pressure of ischemic stroke at the secondary stroke prevention session I.
The management strategy made a special report, the article is organized as follows
.
The author of this article: Yimaitong Tiantan will report the report group Yimaitong compiled reports, please do not reprint without authorization
.
The cross-sectional survey on the burden of stroke disease in China hosted by the Ness-China collaborative research group included 480,687 people.
The results showed that among stroke patients, the proportion of patients with hypertension was the highest, as high as 84.
24%
.
A systematic analysis of the global burden of disease in 2013 analyzed the burden of stroke and its risk factors in 188 countries.
The results showed that hypertension ranked first in the ranking of stroke risk factors
.
Therefore, from the hospital to the out-of-hospital, the blood pressure management of patients with ischemic stroke is the key
.
Acute blood pressure management ➤ The SITS-ISTR study of patients with intravenous thrombolysis shows that with the decrease of blood pressure before thrombolysis, the patient's functional prognosis can be significantly improved
.
The IST-3 study also showed that for patients with acute ischemic stroke treated by thrombolysis, the use of antihypertensive drugs within 24 hours of onset can significantly reduce the patient's early mortality and improve the functional prognosis at 6 months
.
Chinese and foreign guidelines for blood pressure management recommendations for patients with intravenous thrombolysis: The 2019 AHA/ASA guidelines for early management of acute ischemic stroke point out that patients with intravenous alteplase thrombolytic indications but elevated blood pressure should be cautiously Blood pressure before embolization <185/110mmHg
.
The 2019 China Clinical Management Guidelines for Cerebrovascular Diseases pointed out that patients with elevated blood pressure and other aspects suitable for intravenous alteplase treatment should be cautiously lowered blood pressure before thrombolysis, so that systolic blood pressure is less than 180mmHg and diastolic blood pressure is less than 100mmHg
.
The blood pressure within 24 hours after intravenous alteplase thrombolysis should be less than 180/100mmHg
.
➤The domestic and foreign guidelines for patients with endovascular treatment consistently recommend that patients with ischemic stroke undergoing endovascular treatment should control their blood pressure before and after
.
The 2019 AHA/ASA guidelines for the early management of acute ischemic stroke pointed out that it is reasonable to control the preoperative blood pressure of ≤185/110mmHg for patients who have not received intravenous thrombolysis and plan intraarterial treatment before new evidence appears
.
The 2018 China Guidelines for Endovascular Treatment of Acute Ischemic Stroke pointed out that the blood pressure before endovascular treatment should be controlled below 180/105mmHg.
During mechanical thrombectomy and within 24 hours after treatment, blood pressure should be controlled within 180/105mmHg
.
➤Non-venous thrombolysis/endovascular therapy patients.
For patients with non-thrombolysis/endovascular therapy, the benefits of acute blood pressure reduction are not clear
.
The 2019 AHA/ASA guidelines for the early management of acute ischemic stroke indicate that for patients with blood pressure <220/120mmHg, who have not received alteplase thrombolytic therapy or endovascular therapy, and have no comorbidities that require emergency antihypertensive therapy, after AIS The benefit of starting or restarting antihypertensive therapy within the first 48-72h is not yet clear
.
The 2018 Chinese Acute Ischemic Stroke Diagnosis and Treatment Guidelines point out that for patients with stable conditions after stroke, if the blood pressure continues to be ≥140/90mmHg and there are no contraindications, antihypertensive treatment can be initiated a few days later
.
The 2019 Chinese Clinical Management Guidelines for Cerebrovascular Diseases pointed out that for patients with blood pressure <220/120mmHg, who have not received intravenous alteplase or intravascular treatment, and have no comorbidities that require emergency antihypertensive treatment, start within the first 48-72h after AIS Or restarting antihypertensive therapy is not effective in preventing death or severe disability
.
Secondary prevention blood pressure management 2014 AHA/ASA ischemic stroke/TIA secondary prevention guidelines pointed out that antihypertensive therapy may be the most important intervention in the secondary prevention of ischemic stroke
.
The 2017 Canadian Stroke Secondary Prevention Guidelines pointed out that hypertension is the most important independently controllable risk factor for stroke, and blood pressure monitoring and management should be carried out for all people at risk of stroke
.
The 2014 China Guidelines for Secondary Prevention of Ischemic Stroke/TIA pointed out that hypertension is the main risk factor for stroke and TIA
.
There is a close relationship between early morning blood pressure and cardiovascular events.
The incidence of acute myocardial infarction at 9 am is three times that of 11 pm, and 44% of ischemic strokes occur in the early morning.
Therefore, controlling early morning blood pressure is to improve blood pressure management The key to quality
.
Summary Hypertension is the number one risk factor for stroke, so blood pressure control is essential to reduce the risk of stroke
.
For patients with acute ischemic stroke intravenous thrombolysis and endovascular therapy, blood pressure should be actively lowered.
For patients with non-venous thrombolysis/endovascular therapy, blood pressure management is still inconclusive and needs to be handled carefully according to individual conditions
.
The secondary prevention and antihypertensive treatment of ischemic stroke is of great significance, and the control of early morning blood pressure is the key to improving the quality of blood pressure management
.
Lock the medlive-neurology channel to view the latest information of CSA & TISC 2021 at the same time! Long press the QR code to follow the CSA & TISC 2021 special report ☟☟☟ You can also click "Read the original text" to view More CSA & TISC 2021 topics related content!
Sun Yongan from Peking University First Hospital gave an assessment of the blood pressure of ischemic stroke at the secondary stroke prevention session I.
The management strategy made a special report, the article is organized as follows
.
The author of this article: Yimaitong Tiantan will report the report group Yimaitong compiled reports, please do not reprint without authorization
.
The cross-sectional survey on the burden of stroke disease in China hosted by the Ness-China collaborative research group included 480,687 people.
The results showed that among stroke patients, the proportion of patients with hypertension was the highest, as high as 84.
24%
.
A systematic analysis of the global burden of disease in 2013 analyzed the burden of stroke and its risk factors in 188 countries.
The results showed that hypertension ranked first in the ranking of stroke risk factors
.
Therefore, from the hospital to the out-of-hospital, the blood pressure management of patients with ischemic stroke is the key
.
Acute blood pressure management ➤ The SITS-ISTR study of patients with intravenous thrombolysis shows that with the decrease of blood pressure before thrombolysis, the patient's functional prognosis can be significantly improved
.
The IST-3 study also showed that for patients with acute ischemic stroke treated by thrombolysis, the use of antihypertensive drugs within 24 hours of onset can significantly reduce the patient's early mortality and improve the functional prognosis at 6 months
.
Chinese and foreign guidelines for blood pressure management recommendations for patients with intravenous thrombolysis: The 2019 AHA/ASA guidelines for early management of acute ischemic stroke point out that patients with intravenous alteplase thrombolytic indications but elevated blood pressure should be cautiously Blood pressure before embolization <185/110mmHg
.
The 2019 China Clinical Management Guidelines for Cerebrovascular Diseases pointed out that patients with elevated blood pressure and other aspects suitable for intravenous alteplase treatment should be cautiously lowered blood pressure before thrombolysis, so that systolic blood pressure is less than 180mmHg and diastolic blood pressure is less than 100mmHg
.
The blood pressure within 24 hours after intravenous alteplase thrombolysis should be less than 180/100mmHg
.
➤The domestic and foreign guidelines for patients with endovascular treatment consistently recommend that patients with ischemic stroke undergoing endovascular treatment should control their blood pressure before and after
.
The 2019 AHA/ASA guidelines for the early management of acute ischemic stroke pointed out that it is reasonable to control the preoperative blood pressure of ≤185/110mmHg for patients who have not received intravenous thrombolysis and plan intraarterial treatment before new evidence appears
.
The 2018 China Guidelines for Endovascular Treatment of Acute Ischemic Stroke pointed out that the blood pressure before endovascular treatment should be controlled below 180/105mmHg.
During mechanical thrombectomy and within 24 hours after treatment, blood pressure should be controlled within 180/105mmHg
.
➤Non-venous thrombolysis/endovascular therapy patients.
For patients with non-thrombolysis/endovascular therapy, the benefits of acute blood pressure reduction are not clear
.
The 2019 AHA/ASA guidelines for the early management of acute ischemic stroke indicate that for patients with blood pressure <220/120mmHg, who have not received alteplase thrombolytic therapy or endovascular therapy, and have no comorbidities that require emergency antihypertensive therapy, after AIS The benefit of starting or restarting antihypertensive therapy within the first 48-72h is not yet clear
.
The 2018 Chinese Acute Ischemic Stroke Diagnosis and Treatment Guidelines point out that for patients with stable conditions after stroke, if the blood pressure continues to be ≥140/90mmHg and there are no contraindications, antihypertensive treatment can be initiated a few days later
.
The 2019 Chinese Clinical Management Guidelines for Cerebrovascular Diseases pointed out that for patients with blood pressure <220/120mmHg, who have not received intravenous alteplase or intravascular treatment, and have no comorbidities that require emergency antihypertensive treatment, start within the first 48-72h after AIS Or restarting antihypertensive therapy is not effective in preventing death or severe disability
.
Secondary prevention blood pressure management 2014 AHA/ASA ischemic stroke/TIA secondary prevention guidelines pointed out that antihypertensive therapy may be the most important intervention in the secondary prevention of ischemic stroke
.
The 2017 Canadian Stroke Secondary Prevention Guidelines pointed out that hypertension is the most important independently controllable risk factor for stroke, and blood pressure monitoring and management should be carried out for all people at risk of stroke
.
The 2014 China Guidelines for Secondary Prevention of Ischemic Stroke/TIA pointed out that hypertension is the main risk factor for stroke and TIA
.
There is a close relationship between early morning blood pressure and cardiovascular events.
The incidence of acute myocardial infarction at 9 am is three times that of 11 pm, and 44% of ischemic strokes occur in the early morning.
Therefore, controlling early morning blood pressure is to improve blood pressure management The key to quality
.
Summary Hypertension is the number one risk factor for stroke, so blood pressure control is essential to reduce the risk of stroke
.
For patients with acute ischemic stroke intravenous thrombolysis and endovascular therapy, blood pressure should be actively lowered.
For patients with non-venous thrombolysis/endovascular therapy, blood pressure management is still inconclusive and needs to be handled carefully according to individual conditions
.
The secondary prevention and antihypertensive treatment of ischemic stroke is of great significance, and the control of early morning blood pressure is the key to improving the quality of blood pressure management
.
Lock the medlive-neurology channel to view the latest information of CSA & TISC 2021 at the same time! Long press the QR code to follow the CSA & TISC 2021 special report ☟☟☟ You can also click "Read the original text" to view More CSA & TISC 2021 topics related content!
