在急性缺血性中风患者中,早期与延迟的抗高血压治疗:多中心,开放标签,随机化,受控试验
Liping Liu1,2, Xuewei Xie1,2, Yuesong Pan1,2
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
BMJ (Clinical research ed.)
|October 9, 2023
概括
对急性缺血性中风的早期抗高血压治疗没有减少依赖或死亡. 这项研究比较了即时治疗与延迟治疗,在90天后的结果中没有发现显著差异.
科学领域:
- 神经学 神经学
- 心脏病学 心脏病学
- 临床试验 临床试验
背景情况:
- 急性缺血性中风是导致死亡和残疾的主要原因.
- 在急性中风护理中,血压管理至关重要.
- 开始抗高血压治疗的最佳时间仍在争论中.
研究的目的:
- 为了比较早期与延迟抗高血压治疗对急性缺血性中风患者的功能依赖或死亡的影响.
- 评估在中风发作后24-48小时内开始服用降血压药物的安全性和有效性.
主要方法:
- 一个多中心的,随机的,开放的标签试验,涉及4810名急性缺血性中风和高血压的患者.
- 患者被分配到即时的抗高血压治疗或从第8天开始的延迟治疗.
- 主要结局是功能依赖 (修改的兰金级评分≥3) 或90天死亡的复合结果.
主要成果:
- 早期治疗显著降低了缩血压,与延迟治疗相比,在24小时内和7天内.
- 尽管早些时候实现了较低的血压目标,但早期治疗组在90天后显示出非显著的依赖或死亡率较高的趋势 (12.0%vs10.5%).
- 两组之间没有观察到复发性中风或不良事件的显著差异.
结论:
- 在急性缺血性中风发作后24-48小时内开始的早期抗高血压治疗并没有降低在90天内依赖或死亡的几率.
- 研究结果表明,对于轻度至中度缺血性中风和静脉压在140-220毫米升之间患者,立即降低血压可能没有益处.
- 可能需要进一步的研究来确定可能受益于早期抗高血压干预的特定患者亚组.
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