课件：ISC急性脑卒中降压治疗的争论.ppt

2010 AHA脑出血指南 In patients presenting with a systolic BP of 150 to 220 mm Hg, acute lowering of systolic BP to 140 mm Hg is probably safe Class IIa; Level of Evidence: B New recommendation THANK YOU SUCCESS * * 可编辑 2009 CHHIPS 研究 a randomised, placebo-controlled,double-blind pilot trial six centres in the UK (Leicester,Newcastle-upon-Tyne, Exeter, Bournemouth, Liverpool,and Wansbeck) labetolol (n=58) lisinopril (n=58) oral labetalol,lisinopril if they were non-dysphagic or intravenous labetalol, sublingual lisinopril if they had dysphagia 36h CI or ICH and Hypertensive SBP160 mm Hg placebo (n=63) death or dependency at 2 weeks 90d，Alive Clinical outcome placebo Clinical outcome Lancet Neurol. 2009 ;8:48-56 血压的变化 第1个24h内，治疗组SBP下降21(17–25) mmHg，对照组下降11(5–17)mmHg，p=0·004 p=0·004 Lancet Neurol. 2009 ;8:48-56 Lancet Neurol. 2009 ;8:48-56 CHHIPS 主要结果 Lancet Neurol. 2009 ;8:48-56 神经功能恶化 Lancet Neurol. 2009 ;8:48-56 累积危害 Lancet Neurol. 2009 ;8:48-56 PRoFESS Subgroup Analysis Stroke. 2009 Sep 24 PRoFESS Subgroup Analysis Stroke. 2009 Sep 24 COSSACS研究 UK multicentre,prospective, randomised, open, blinded-endpoint trial Continue=379 continue pre-existing antihypertensive drugs for 2 weeks within 48h ischaemic or haemorrhagic stroke within 48h of the last dose of antihypertensive drugs Stop=384 death or dependency at 2 weeks Clinical outcome stop pre-existing antihypertensive drugs for 2 weeks Lancet Neurol. 2010 Aug;9(8):767-75. 2W Death or Dependency Lancet Neurol. 2010 Aug;9(8):767-75. Kaplan-Meier survival estimates Lancet Neurol. 2010 Aug;9(8):767-75. SCAST trial 146 centres in nine north European countries, a randomised, placebo-controlled,double-blind trial candesartan=1017 candesartan for 7 days, 4 mg on day 1 , 16 mg on days 3 to 7 acute stroke within 30 h of symptom onset SBP=140 mm Hg placebo=1012 Vascular death, MI, stroke at 6 months Clinical outcome placebo Lancet. 2011 Feb 26;377(9767):741-50 functional outcome at 6m BP during 7 days’ treatmen