[Hypertension associated with cerebrovascular disease]

Area of Science:

• Neurology
• Cardiology
• Pharmacology

Context:

• Hypertension management in cerebrovascular disease requires tailored blood pressure targets.
• Guidelines, such as the Japanese Society of Hypertension 2014 (JSH2014), inform treatment decisions.
• Factors influencing targets include disease type, phase, severity, age, and antithrombotic drug use.

Purpose:

• To outline blood pressure control targets for hypertensive patients with cerebrovascular disease.
• To detail antihypertensive therapy indications and recommended drug classes.

Summary:

• In acute cerebral infarction without thrombolysis, target 85-90% of pre-treatment BP if SBP > 220 mmHg or DBP > 120 mmHg.
• For acute cerebral hemorrhage, treat if SBP > 180 mmHg or MAP > 130 mmHg, targeting < 140/90 mmHg.
• Chronic phases and specific conditions like lacunar infarction or antithrombotic use may target < 130/80 mmHg.
• Oral agents like Ca channel blockers, ACE inhibitors, ARBs, and diuretics are recommended.

Impact:

• Provides clear, evidence-based guidelines for managing blood pressure in complex neurological and cardiovascular patient populations.
• Aims to reduce morbidity and mortality associated with cerebrovascular events in hypertensive individuals.
• Facilitates informed clinical decision-making for healthcare providers treating patients with comorbid hypertension and cerebrovascular conditions.