急性缺血性脑血管病血压管理指南

Recommendations2.PatientswhohaveelevatedbloodpressureandareotherwiseeligiblefortreatmentwithintravenousrtPAshouldhavetheirbloodpressurecarefullylowered(Table9)sothattheirsystolicbloodpressureis<185mmHgandtheirdiastolicbloodpressureis<110mmHg

(ClassI;LevelofEvidenceB)beforefibrinolytictherapyisinitiated.Ifmedicationsaregiventolowerbloodpressure,theclinicianshouldbesurethatthebloodpressureisstabilizedatthelowerlevelbeforebeginningtreatmentwithintravenousrtPAandmaintainedbelow180/105mmHgforatleastthefirst24hoursafterintravenousrtPAtreatment.(Unchangedfromthepreviousguideline13)Table9.PotentialApproachestoArterialHypertensioninAcuteIschemicStrokePatientsWhoAreCandidatesforAcuteReperfusionTherapyPatientotherwiseeligibleforacutereperfusiontherapyexceptthatBPis>185/110mmHg:

Labetalol10–20mgIVover1–2minutes,mayrepeat1time;or

Nicardipine5mg/hIV,titrateupby2.5mg/hevery5–15minutes,maximum5mg/h;whendesiredBPreached,adjusttomaintainproperBPlimits;orOtheragents(hydralazine,enalaprilat,etc)maybeconsideredwhenappropriateIfBPisnotmaintainedatorbelow185/110mmHg,donotadministerrtPAManagementofBPduringandafterrtPAorotheracutereperfusiontherapytomaintainBPatorbelow180/105mmHg:MonitorBPevery15minutesfor2hoursfromthestartofrtPAtherapy,thenevery30minutesfor6hours,andtheneveryhourfor16hoursIfsystolicBP>180–230mmHgordiastolicBP>105–120mmHg:

Labetalol10mgIVfollowedbycontinuousIVinfusion2–8mg/min;or

Nicardipine5mg/hIV,titrateuptodesiredeffectby2.5mg/hevery5–15minutes,maximum15mg/hIfBPnotcontrolledordiastolicBP>140mmHg,considerIVsodiumnitroprusside

7.Inpatientswithmarkedlyelevatedbloodpressurewhodonotreceivefibrinolysis,areasonablegoalistolowerbloodpressureby15%duringthefirst24hoursafteronsetofstroke.Thelevelofbloodpressurethatwouldmandatesuchtreatmentisnotknown,butconsensusexiststhatmedicationsshouldbewithheldunlessthesystolicbloodpressureis>220mmHgorthediastolic

bloodpressureis>120mmHg

(ClassI;LevelofEvidenceC).(Revisedfromtheprevious

guideline13)10.Evidencefromoneclinicaltrialindicatesthatinitiationofantihypertensivetherapywithin24hoursofstrokeisrelativelysafe.Restartingantihypertensivemedicationsisreasonableafterthefirst24hoursforpatientswhohavepreexistinghypertensionandareneurologicallystableunlessaspecificcontraindicationtorestartingtreatmentisknown(ClassIIa;Level

ofEvidenceB).(Revisedfromthepreviousguideline13)11.Nodataareavailabletoguideselectionofmedicationsfortheloweringofbloodpressureinthesettingofacuteischemicstroke.TheantihypertensivemedicationsanddosesincludedinTable9arereasonablechoicesbasedongeneralconsensus(ClassIIa;Level

ofEvidenceC).(Revisedfromthepreviousguideline13)13.Themanagementofarterialhypertensioninpatientsnotundergoingreperfusionstrategiesremainschallenging.Datatoguiderecommendationsfortreatmentareinconclusive(不确定的)orconflicting（冲突的）.Manypatientshavespontaneousdeclinesinbloodpressureduringthefirst24hoursafteronsetofstroke.Untilmoredefinitivedataareavailable,thebenefitoftreatingarterialhypertensioninthesettingofacuteischemicstrokeisnotwellestablished(ClassIIb;Levelof

Evide