中国卒中患者高血压管理专家共识

doi:10.3969/j.issn.1673-5765.2024.06.009

摘要/Abstract

摘要： 卒中后血压升高与患者死亡和神经功能恢复不良相关，积极有效地控制血压对改善预后非常重要。《中国卒中患者高血压管理专家共识》基于现有循证医学证据，对出血性卒中和缺血性卒中早期降压治疗的时机、目标和用药措施进行了推荐；考虑到临床实际中多病共存的现状，还对合并心力衰竭、颈部大血管狭窄、主动脉夹层、肾功能衰竭、心房颤动、肺部感染等特殊病情卒中患者的降压时机、目标和用药措施进行了推荐；同时就卒中一级、二级预防中的血压管理进行了介绍。《中国卒中患者高血压管理专家共识》的发布有利于临床实践中卒中患者高血压的规范化管理。

关键词: 卒中; 高血压; 降压; 治疗

Abstract: Stroke patients with elevated blood pressure are associated with death and poor recovery of neurological function. Active and effective blood pressure control is very important for improving prognosis. Based on existing evidence-based medical evidence, this consensus recommended the timing, target, and medication measures for early blood pressure reduction therapy for hemorrhagic and ischemic stroke. Considering the current situation of multiple diseases coexisting in clinical practice, the consensus also recommended the timing, target, and medication measures of blood pressure reduction in stroke patients with special conditions such as heart failure, carotid artery stenosis, aortic dissection, renal failure, atrial fibrillation, and pulmonary infection. At the same time, the consensus introduced the content of blood pressure management for primary and secondary prevention of stroke. It is conducive to guiding the standardized management of hypertension in stroke patients in clinical practice.

Key words: Stroke; Hypertension; Blood pressure reduction; Treatment

中图分类号:

北京高血压防治协会, 中国卒中学会高血压预防与管理分会. 中国卒中患者高血压管理专家共识[J]. 中国卒中杂志, 2024, 19(6): 672-698.

Beijing Hypertension Association, Chinese Stroke Association Hypertension Prevention and Management Branch. Chinese Expert Consensus on Hypertension Management in Stroke Patients[J]. Chinese Journal of Stroke, 2024, 19(6): 672-698.

参考文献

[1] KAZUI S，NARITOMI H，YAMAMOTO H，et al. Enlargement of spontaneous intracerebral hemorrhage. Incidence and time course[J]. Stroke，1996，27（10）：1783-1787.
[2] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南（2019）[J]. 中华神经科杂志，2019，52（12）：994-1005.
Chinese Society of Neurology，Chinese Stroke Society. Chinese guidelines for diagnosis and treatment of acute intracerebral hemorrhage 2019[J]. Chin J Neurol，2019，52（12）：994-1005.
[3] ANDERSON C S，HEELEY E，HUANG Y，et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage[J]. N Engl J Med，2013，368（25）：2355-2365.
[4] ARIMA H，HEELEY E，DELCOURT C，et al. Optimal achieved blood pressure in acute intracerebral hemorrhage：INTERACT 2[J]. Neurology，2015，84（5）：464-471.
[5] QURESHI A I，PALESCH Y Y，BARSAN W G，et al. Intensive blood-pressure lowering in patients with acute cerebral hemorrhage[J]. N Engl J Med，2016，375（11）：1033-1043.
[6] MOULLAALI T J，WANG X，MARTIN R H，et al. Blood pressure control and clinical outcomes in acute intracerebral haemorrhage：a preplanned pooled analysis of individual participant data[J]. Lancet Neurol，2019，18（9）：857-864.
[7] LI Q，WARREN A D，QURESHI A I，et al. Ultra-early blood pressure reduction attenuates hematoma growth and improves outcome in intracerebral hemorrhage[J]. Ann Neurol，2020，88（2）：388-395.
[8] MOULLAALI T J，WANG X，SANDSET E C，et al. Early lowering of blood pressure after acute intracerebral haemorrhage：a systematic review and meta-analysis of individual patient data[J]. J Neurol Neurosurg Psychiatry，2022，93（1）：6-13.
[9] MA L，HU X，SONG L L，et al. The third intensive care bundle with blood pressure reduction in acute cerebral haemorrhage trial（INTERACT 3）：an international，stepped wedge cluster randomised controlled trial[J]. Lancet，2023，402（10395）：27-40.
[10] TSIVGOULIS G，KATSANOS A H，BUTCHER K S，et al. Intensive blood pressure reduction in acute intracerebral hemorrhage：a meta-analysis[J]. Neurology，2014，83（17）：1523-1529.
[11] QURESHI A I，HUANG W，LOBANOVA I，et al. Outcomes of intensive systolic blood pressure reduction in patients with intracerebral hemorrhage and excessively high initial systolic blood pressure：post hoc analysis of a randomized clinical trial[J]. JAMA Neurol，2020，77（11）：1355-1365.
[12] MANNING L，HIRAKAWA Y，ARIMA H，et al. Blood pressure variability and outcome after acute intracerebral haemorrhage：a post-hoc analysis of INTERACT 2，a randomized controlled trial[J]. Lancet Neurol，2014，13（4）：364-373.
[13] WANG X，DI TANNA G L，MOULLAALI T J，et al. J-shape relation of blood pressure reduction and outcome in acute intracerebral hemorrhage：a pooled analysis of INTERACT 2 and ATACH-Ⅱ individual participant data[J]. Int J Stroke，2022，17（10）：1129-1136.
[14] DIVANI A A，LIU X，PETERSEN A，et al. The magnitude of blood pressure reduction predicts poor in-hospital outcome in acute intracerebral hemorrhage[J]. Neurocrit Care，2020，33（2）：389-398.
[15] BUTCHER K S，JEERAKATHIL T，HILL M，et al. The intracerebral hemorrhage acutely decreasing arterial pressure trial[J]. Stroke，2013，44（3）：620-626.
[16] QURESHI A I，FOSTER L D，LOBANOVA I，et al. Intensive blood pressure lowering in patients with moderate to severe grade acute cerebral hemorrhage：post hoc analysis of antihypertensive treatment of acute cerebral hemorrhage（ATACH）-2 trial[J]. Cerebrovasc Dis，2020，49（3）：244-252.
[17] WIJDICKS E F，VERMEULEN M，MURRAY G D，et al. The effects of treating hypertension following aneurysmal subarachnoid hemorrhage[J]. Clin Neurol Neurosurg，1990，92（2）：111-117.
[18] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组，中华医学会神经病学分会神经血管介入协作组. 中国蛛网膜下腔出血诊治指南2019[J]. 中华神经科杂志，2019，52（12）：1006-1021.
Chinese Society of Neurology，Chinese Stroke Society，Neurovascular Intervention Group of Chinese Society of Neurology. Chinese guidelines for diagnosis and treatment of subarachnoid hemorrhage 2019[J]. Chin J Neurol，2019，52（12）：1006-1021.
[19] DURAN L，BALCI K，KATI C，et al. Has admission blood pressure any prognostic value in patients with subarachnoid hemorrhage：an emergency department experience[J]. J Clin Hypertens（Greenwich），2013，15（10）：737-741.
[20] SPRIGG N，GRAY L J，BATH P M，et al. Relationship between outcome and baseline blood pressure and other haemodynamic measures in acute ischaemic stroke：data from the TAIST trial[J]. J Hypertens，2006，24（7）：1413-1417.
[21] LEE M，OVBIAGELE B，HONG K S，et al. Effect of blood pressure lowering in early ischemic stroke：metaanalysis[J]. Stroke，2015，46（7）：1883-1889.
[22] HE J，ZHANG Y H，XU T，et al. Effects of immediate blood pressure reduction on death and major disability in patients with acute ischemic stroke：the CATIS randomized clinical trial[J]. JAMA，2014，311（5）：479-489.
[23] XU T，ZHANG Y H，BU X，et al. Blood pressure reduction in acute ischemic stroke according to time to treatment：a subgroup analysis of the China antihypertensive trial in acute ischemic stroke trial[J]. J Hypertens，2017，35（6）：1244-1251.
[24] LIU L P，XIE X W，PAN Y S，et al. Early versus delayed antihypertensive treatment in patients with acute ischaemic stroke：multicentre，open label，randomised，check for updates controlled trial[J/OL]. BMJ，2023，383：e076448[2024-04-10]. https://doi.org/10.1136/bmj-2023-076448.
[25] BERGE E，COHEN G，LINDLEY R I，et al. Effects of blood pressure and blood pressure-lowering treatment during the first 24 hours among patients in the third international stroke trial of thrombolytic treatment for acute ischemic stroke[J]. Stroke，2015，46（12）：3362-3369.
[26] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国缺血性卒中和短暂性脑缺血发作二级预防指南2022[J]. 中华神经科杂志，2022，55（10）：1071-1110.
Chinese Society of Neurology，Chinese Stroke Society. Chinese guideline for the secodary prevention of ischemic stroke and transient ischemic attack 2022[J]. Chin J Neurol，2022，55（10）：1071-1110.
[27] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国急性缺血性卒中诊治指南2023[J]. 中华神经科杂志，2024，57（6）：523-559.
Chinese Society of Neurology，Chinese Stroke Society. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2023[J]. Chin J Neurol，2024，57（6）：523-559.
[28] BENAVENTE O R，COFFEY C S，CONWIT R，et al. Blood-pressure targets in patients with recent lacunar stroke：the SPS3 randomised trial[J]. Lancet，2013，382（9891）：507-515.
[29] TURAN T N，COTSONIS G，LYNN M J，et al. Relationship between blood pressure and stroke recurrence in patients with intracranial arterial stenosis[J]. Circulation，2007，115（23）：2969-2975.
[30] CHATURVEDI S，TURAN T N，LYNN M J，et al. Risk factor status and vascular events in patients with symptomatic intracranial stenosis[J]. Neurology，2007，69（22）：2063-2068.
[31] TURAN T N，NIZAM A，LYNN M J，et al. Relationship between risk factor control and vascular events in the SAMMPRIS trial[J]. Neurology，2017，88（4）：379-385.
[32] POWERS W J，RABINSTEIN A A，ACKERSON T，et al. 2018 guidelines for the early management of patients with acute ischemic stroke. a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J/OL]. Stroke，2018，49（3）：e46-e110[2024-04-10]. https://doi.org/10.1161/str.0000000000000211.
[33] SMITH W S，YAN B. REVASCAT trial：further advancement in endovascular stroke therapy[J]. Stroke，2015，46（10）：3012-3013.
[34] SAVER J L，JAHAN R，LEVY E I，et al. Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke（SWIFT）：a randomised，parallel-group，noninferiority trial[J]. Lancet，2012，380（9849）：1241-1249.
[35] CAMPBELL B C，MITCHELL P J，YAN B，et al. A multicenter，randomized，controlled study to investigate extending the time for thrombolysis in emergency neurological deficits with intra-arterial therapy（EXTEND IA）[J]. Stroke，2014，9（1）：126-132.
[36] BRACARD S，DUCROCQ X，MAS J L，et al. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke（THRACE）：a randomised controlled trial[J]. Lancet Neurol，2016，15（11）：1138-1147.
[37] DIENER H C，NITSCHMANN S. Endovaskuläre therapie bei akutem ischämischem insult：multicenter randomized clinical trial of endovascular treatment for acute ischemic stroke in the Netherlands（MR CLEAN）[J]. Internist（Berl），2015，56（7）：847-850.
[38] MAÏER B，GORY B，TAYLOR G，et al. Mortality and disability according to baseline blood pressure in acute ischemic stroke patients treated by thrombectomy：acollaborative pooled analysis[J/OL]. J Am Heart Assoc，2017，6（10）：e006484[2024-04-10]. https://doi.org/10.1161/JAHA.117.006484.
[39] MULDER M，ERGEZEN S，LINGSMA HF，et al. Baseline blood pressure effect on the benefit and safety of intraarterial treatment in MR CLEAN（multicenter randomized clinical trial of endovascular treatment of acute ischemic stroke in the Netherlands）[J]. Stroke，2017，48（7）：18691876.
[40] CHEN M，MEIS J，POTRECK A，et al. Effect of individualized versus standardized blood pressure management during endovascular stroke treatment on clinical outcome：a randomized clinical trial[J]. Stroke，2023，54（11）：2755-2765.
[41] KATSANOS A H，MALHOTRA K，AHMED N，et al. Blood pressure after endovascular thrombectomy and outcomes in patients with acute ischemic stroke：an individual patient data meta-analysis[J/OL]. Neurology，2022，98（3）：e291-e301[2024-04-10]. https://doi.org/10.1212/WNL.0000000000013049.
[42] YANG P F，SONG L L，ZHANG Y W，et al. Intensive blood pressure control after endovascular thrombectomy for acute ischaemic stroke（ENCHANTED2/MT）：a multicentre，open-label，blinded-endpoint，randomised controlled trial[J]. Lancet，2022，400（10363）：1585-1596.
[43] NAM H S，KIM Y D，HEO J，et al. Intensive vs. conventional blood pressure lowering after endovascular thrombectomy in acute ischemic stroke：the OPTIMAL-BP randomized clinical trial[J]. JAMA，2023，330（9）：832-842.
[44] MATUSEVICIUS M，COORAY C，BOTTAI M，et al. Blood pressure after endovascular thrombectomy：modeling for outcomes based on recanalization status[J]. Stroke，2020，51（2）：519-525.
[45] MISTRY E A，KHATRI P. Response by Mistry and Khatri to letter regarding article，blood pressure after endovascular therapy for ischemic stroke（BEST）：amulticenter prospective cohort study[J/OL]. Stroke，2020，51（2）：e41[2024-04-10]. https://doi.org/10.1161/STROKEAHA.119.028470.
[46] NG Y，QI W J，KING N K K，et al. Initial antihypertensive agent effects on acute blood pressure after intracerebral haemorrhage[J]. Stroke Vasc Neurol，2022，7（5）：367-374.
[47] 陈灏珠，林果为. 实用内科学[M]. 16版. 北京：人民卫生出版社，2022.
CHEN H Z，LIN G W. Practical of internal medicine[M]. 16th ed. Beijing：People’s Medical Publishing House，2022.
[48] MULLEN M T，ANDERSON C S. Review of long-term blood pressure control after intracerebral hemorrhage：challenges and opportunities[J]. Stroke，2022，53（7）：2142-2151.
[49] 中国医师协会神经外科医师分会神经重症专家委员会，中华医学会神经外科学分会脑血管病学组，中国医师协会神经介入专业委员会，等. 重症动脉瘤性蛛网膜下腔出血管理专家共识（2023）[J]. 中国脑血管病杂志，2023，20（2）：126-144.
Neurointensive Care Expert Committee of Chinese Neurosurgeons Association；Cerebrovascular Group，Chinese Neurosurgical Society；Chinese Federation of Interventional Clinical Neurosciences（CFITN），et al. Expert consensus on the management of severe aneurysmal subarachnoid hemorrhage 2023[J]. Chin J Cerebrovasc Dis，2023，20（2）：126-144.
[50] 吕传真，周良辅. 实用神经病学[M]. 5版. 上海：上海科学技术出版社，2021.
LYU C Z，ZHOU L F. Practical neurology[M]. 5th ed. Shanghai：Shanghai Scientific & Technical Publishers，2021.
[51] DAYYANI M，SADEGHIRAD B，GROTTA J C，et al. Prophylactic therapies for morbidity and mortality after aneurysmal subarachnoid hemorrhage：a systematic review and network meta-analysis of randomized trials[J]. Strok，2022，53（6）：1993-2005.
[52] 中国医疗保健国际交流促进会心脏重症专业委员会，中华医学会急诊医学分会县域急诊急救学组，中国医学教育学会急诊医学分会基层急救分会，等. 盐酸乌拉地尔注射液临床应用多学科专家共识（2023）[J]. 中华急诊医学杂志，2023，32（3）：305-313.
Cardiac Critical Care Medicine Committee of China Internationgnal Exchange and Promotive Association for Medical and Health Care，County Emergency Group of Chinese Society of Emergency Medicine，Basic Emergency Medicine Branch of Chinese Medical Education Society，et al. Multidisciplinary expert consensus on clinical application of urapidil hydrochloride injection（2023）[J]. Chin J Emerg Med，2023，32（3）：305-313.
[53] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组，中华医学会神经病学分会神经血管介入协作组. 中国急性缺血性卒中早期血管内介入诊疗指南2022[J]. 中华神经科杂志，2022，55（6）：565-580.
Chinese Society of Neurology，Chinese Stroke Society，Neurovascular Intervention Group of Chinese Society of Neurology，et al. Chinese guidelines for the endovascular treatment of acute ischemic stroke 2022[J]. Chin J Neurol，2022，55（6）：565-580.
[54] ALIJOTAS-REIG J，BOVE-FARRE I，de CABO-FRANCES F，et al. Effectiveness and safety of prehospital urapidil for hypertensive emergencies[J]. Am J Emerg Med，2001，19（2）：130-133.
[55] LI Y J，ZHONG Z G，LUO S B，et al. Efficacy of antihypertensive therapy in the acute stage of cerebral infarction—a prospective，randomized control trial[J]. Acta Cardiol Sin，2018，34（6）：502-510.
[56] PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack[J]. Lancet，2001，358（9287）：1033-1041.
[57] SHEN X Z，GONG C，LIU M Q，et al. Effect of sacubitril/valsartan on brain natriuretic peptide level and prognosis of acute cerebral infarction[J/OL]. PLoS One，2023，18（9）：e0291754[2024-04-10]. https://doi.org/10.1371/journal.pone.0291754.
[58] YANG M M，KONDO T，BUTT J H，et al. Stroke in patients with heart failure and reduced or preserved ejection fraction[J]. Eur Heart J. 2023，44（31）：2998-3013.
[59] TAN S，HO CESM，TEO Y N，et al. Prevalence and incidence of stroke，white matter hyperintensities，and silent brain infarcts in patients with chronic heart failure：a systematic review，meta-analysis，and meta-regression[J/OL]. Front Cardiovasc Med，2022，9：967197[2024-04-10]. https://doi.org/10.3389/fcvm.2022.967197.
[60] ABOVICH A，MATASIC D S，CARDOSO R，et al. The AHA/ACC/HFSA 2022 heart failure guidelines：changing the focus to heart failure prevention[J/OL]. Am J Prev Cardiol，2023，15：100527[2024-04-10]. https://doi.org/10.1016/j.ajpc.2023.100527.
[61] PETERMANN-ROCHA F，DEO S，CELIS-MORALES C，et al. An opportunity for prevention：associations between the life’s essential 8 score and cardiovascular incidence using prospective data from UK Biobank[J/OL]. Curr Prob Cardiology，2022，48（4）：101540[2024-04-10]. https://doi.org/10.1016/j.cpcardiol.2022.101540.
[62] 中华医学会心血管病学分会，中国医师协会心血管内科医师分会，中国医师协会心力衰竭专业委员会，等. 中国心力衰竭诊断和治疗指南2024[J]. 中华心血管病杂志，2024，52（3）：235-275.
Chinese Society of Cardiology，Chinese Medical Association；Chinese College of Cardiovascular Physician；Chinese Heart Failure Association of Chinese Medical Doctor Association，et al. Chinese guidelines for the diagnosis and treatment of heart failure 2024[J]. Chin J Cardiol，2018，46（10）：760-789.
[63] KHAN S S，NING H，SHAH S J，et al. 10-year risk equations for incident heart failure in the general population[J]. J Am Coll Cardiol，2019，73（19）：2388-2397.
[64] HEIDENREICH P A，BOZKURT B，AGUILAR D，et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure：executive summary：a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines[J/OL]. Circulation，2022，145（18）：e876-e894[2024-04-10]. https://doi.org/10.1161/cir.0000000000001063.
[65] KIM H L，LEE E M，AHN S Y，et al. The 2022 focused update of the 2018 Korean hypertension society guidelines for the management of hypertension[J/OL]. Clin Hypertens，2023，29（1）：11[2024-04-10]. https://doi.org/10.1186/s40885-023-00234-9.
[66] WACHTER R，SENNI M，BELOHLAVEK J，et al. Initiation of sacubitril/valsartan in haemodynamically stabilised heart failure patients in hospital or early after discharge：primary results of the randomised TRANSITION study[J]. Eur J Heart Fail，2019，21（8）：998-1007.
[67] DESAI A S，SOLOMON S D，SHAH A M，et al. Effect of sacubitril-valsartan vs. enalapril on aortic stiffness in patients with heart failure and reduced ejection fraction：a randomized clinical trial[J]. JAMA，2019，322：1077-1084.
[68] WANG Y M，ZHOU R，LU C，et al. Effects of the angiotensin-receptor neprilysin inhibitor on cardiac reverse remodeling：meta-analysis[J/OL]. J Am Heart Assoc，2019，8：e012272[2024-04-10]. https://doi.org/10.1161/JAHA.119.012272.
[69] PARIZO J T，GOLDHABER-FIEBERT J D，SALOMON J A，et al. Cost-effectiveness of dapagliflozin for treatment of patients with heart failure with reduced ejection fraction[J]. JAMA Cardiol，2021，6（8）：926-935.
[70] 中国医师协会心力衰竭专业委员会，中华心力衰竭和心肌病杂志编辑委员会. 心力衰竭容量管理中国专家建议[J]. 中华心力衰竭和心肌病杂志，2018，2（1）：8-16.
Heart Failure of Chinese Medical Docter Association，Editorial Board of Chinses Jourol of Heart Failure and Cardiomyopathy. Expert recommendation on the voume management in heart failure[J]. Chin J Heart Fail & Cardiomyopathy，2018，2（1）：8-16.
[71] COSTANZO M R，NEGOIANU D，FONAROW G C，et al. Rationale and design of the aquapheresis versus intravenous diuretics and hospitalization for heart failure（AVOID-HF）trial[J]. Am Heart J，2015，170（3）：471-482.
[72] 中华医学会外科学分会血管外科学组. 颈动脉狭窄诊治指南[J]. 中华血管外科杂志，2017，2（2）：78-84.
Vascular Surgery Group，Surgery Branch，Chinese Medical Association. Management of carotid artery stenosis：clinical practice guideline[J]. Chin J Vasc Surg，2017，2（2）：78-84.
[73] 张丽，赵珈艺，范乐，等. 内脏脂肪指数、脂质蓄积指数与脑卒中高危人群颈动脉粥样硬化的相关性研究[J]. 中国动脉硬化杂志，2021，29（3）：240-246.
ZHANG L，ZHAO J Y，FAN L，et al. Association among visceral adipose index，lipid accumulation product and carotid atherosclerosis in the population at high risk of stroke[J]. Chin J Arterioscler，2021，29（3）：240-246.
[74] CHIMOWITZ M I，KOKKINOS J，STRONG J，et al. The warfarin-aspirin symptomatic intracranial disease study[J]. Neurology，1995，45（8）：1488-1493.
[75] DUMONT T M，KAN P，SNYDER K V，et al. Revisiting angioplasty without stenting for symptomatic intracranial atherosclerotic stenosis after the stenting and aggressive medical management for preventing recurrent stroke in intracranial stenosis（SAMMPRIS）study[J]. Neurosurgery，2012，71（6）：1103-1110.
[76] POWERS W J，CLARKE W R，GRUBB R L，et al. Lower stroke risk with lower blood pressure in hemodynamic cerebral ischemia[J]. Neurology，2014，82（12）：1027-1032.
[77] AMIN-HANJANI S，ROSE-FINNELL L，RICHARDSON D，et al. Vertebrobasilar flow evaluation and risk of transient ischaemic attack and stroke study（VERiTAS）：rationale and design[J]. Int J Stroke，2010，5（6）：499-505.
[78] MAZZUCCO S，LI L，MCGURGAN I J，et al. Cerebral hemodynamic effects of early blood pressure lowering after TIA and stroke in patients with carotid stenosis[J]. Int J Stroke，2022，17（10）：1114-1120.
[79] HE M L，CUI B，WANG J E，et al. Focus on blood pressure levels and variability in the early phase of acute ischemic stroke with hypertension and carotid stenosis[J]. Clin Hypertens（Greenwich），2021，23（12）：2089-2099.
[80] KLEINDORFER D O，TOWFIGHI A，CHATURVEDI S，et al. 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack：a guideline from the American Heart Association/American Stroke Association[J/OL]. Stroke，2021，52（7）：e364-e467[2024-04-10]. https://doi.org/10.1161/STR.0000000000000375.
[81] POWERS W J，DERDEYN C P，BILLER J，et al. 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment：a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke，2015，46（10）：3020-3035.
[82] 中国卒中学会科学声明专家组. 症状性颅内外动脉粥样硬化性大动脉狭窄管理规范——中国卒中学会科学声明[J]. 中国卒中杂志，2017，27（1）：64-71.
Scientific Statement Expert Group of Chinese Stroke Association. Management standard of symptomatic intracranial and extracranial atherosclerotic aortic stenosis—scientific statement from the Chinese Stroke Association[J]. Chin J Stroke，2017，27（1）：64-71.
[83] ZONNEVELD T P，RICHARD E，VERGOUWEN M D，et al. Blood pressure-lowering treatment for preventing recurrent stroke，major vascular events，and dementia in patients with a history of stroke or transient ischaemic attack[J/OL]. Cochrane Database Syst Rev，2018，7（7）：CD007858[2024-04-10]. https://doi.org/10.1002/14651858.cd007858.pub2.
[84] 中国医师协会心血管外科分会大血管外科专业委员会. 主动脉夹层诊断与治疗规范中国专家共识[J]. 中华胸心血管外科杂志，2017，33（11）：641-654.
Committee of Great Vessels of Chinese Association of Cardiovascular Surgeons. Chinese experts’ consensus of standardized diagnosis and treatment for aortic dissection[J]. Chin J Thorac Cardiovasc Surg，2017，33（11）：641-654.
[85] 中国高血压防治指南修订委员会，高血压联盟（中国），中华医学会心血管病学分会，等. 中国高血压防治指南（2018年修订版）[J]. 中国心血管杂志，2019，24（1）：24-56.
Writing Group of 2018 Chinese Guidelines for the Management of Hypertension，Chinese Hypertension League，Chinese Society of Cardiology，et al. 2018 Chinese guidelines for the management of hypertension[J]. Chin J Cardiovasc Med，2019，24（1）：24-56.
[86] 中国医师协会急诊医师分会，中国高血压联盟，北京高血压防治协会. 中国急诊高血压诊疗专家共识（2017修订版）[J]. 中国急救医学，2018，38（1）：1-13.
Emergency Medical Branch of Chinese Medical Doctor Association，Chinese Hypertension League，Beijing Hypertension Association. Experts consensus on emergency hypertension diagnosis and treatment in China（2017 revision）[J]. Chin J Crit Care Med，2018，38（1）：1-13.
[87] MANCIA G，KREUTZ R，BRUNSTRÖM M，et al. 2023 ESH guidelines for the management of arterial hypertension the task force for the management of arterial hypertension of the European Society of Hypertension endorsed by the International Society of Hypertension（ISH）and the European Renal Association（ERA）[J]. J Hypertens，2023，41（12）：1874-2071.
[88] ISSELBACHER E M，PREVENTZA O，HAMILTON BLACK J，3rd，et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease：a report of the American Heart Association/American College of Cardiology Joint Committee on clinical practice guidelines[J/OL]. Circulation，2022，146（24）：e334-e482[2024-04-10]. https://doi.org/10.1161/cir.0000000000001106.
[89] 刘丽萍，周宏宇，段婉莹，等. 中国脑血管病临床管理指南（第2版）（节选）——第4章缺血性脑血管病临床管理推荐意见[J]. 中国卒中杂志，2023，18（8）：910-933.
LIU L P，ZHOU H Y，DUAN W Y，el al. Chinese Stroke Association guidelines for clinical management of cerebrovascular diseases（second edition）（excerpt）—chapter four clinical management of ischaemic cerebrovascular diseases[J]. Clin J Stroke，2023，18（8）：910-933.
[90] KELLY D M，ADEMI Z，DOEHNER W，et al. Chronic kidney disease and cerebrovascular disease：consensus and guidance from a KDIGO controversies conference[J/OL]. Stroke，2021，52（7）：e328-e346[2024-04-10]. https://doi.org/10.1161/STROKEAHA.120.029680.
[91] MASSON P，WEBSTER AC，HONG M，et al. Chronic kidney disease and the risk of stroke：a systematic review and meta-analysis[J]. Nephrol Dial Transplant，2015，30（7）：1162-1169.
[92] JAFAR T H，STARK P C，SCHMID C H，et al. Progression of chronic kidney disease：the role of blood pressure control，proteinuria，and angiotensin-converting enzyme inhibition：a patient-level meta-analysis[J]. Ann Intern Med，2003，139（4）：244-252.
[93] WHELTON P K，CAREY R M，ARONOW W S，et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention，detection，evaluation，and management of high blood pressure in adults：a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines[J/OL]. J Am Coll Cardiol，2018，71（19）：e127-e248[2024-04-10]. https://doi.org/10.1016/j.jacc.2017.11.006.
[94] Kidney Disease：Improving Global Outcomes（KDIGO）Blood Pressure Work Group. KDIGO 2021 clinical practice guideline for the management of blood pressure in chronic kidney disease[J/OL]. Kidney Int，2021，99（3S）：S1-S87[2024-04-10]. https://doi.org/10.1016/j.kint.2020.11.003.
[95] ITO S，SATOH M，TAMAKI Y，et al. Safety and efficacy of LCZ696，a first-in-class angiotensin receptor neprilysin inhibitor，in Japanese patients with hypertension and renal dysfunction[J]. Hypertens Res，2015，38（4）：269-275.
[96] CHEIGH J S，MILITE C，SULLIVAN J F，et al. Hypertension is not adequately controlled in hemodialysis patients[J]. Am J Kidney Dis，1992，19（5）：453-459.
[97] 周婷，张爱华. 维持性血液透析患者的血压管理[J]. 中国血液净化，2021，20（5）：294-296.
ZHOU T，ZHANG A H. Blood pressure management in maintenance hemodialysis patients[J]. Chin J Blood Purif，2021，20（5）：294-296.
[98] ROBINSON B M，TONG L，ZHANG J，et al. Blood pressure levels and mortality risk among hemodialysis patients in the dialysis outcomes and practice patterns study[J]. Kidney Int，2012，82（5）：570-580.
[99] KIM D，YANG P S，KIM T H，et al. Ideal blood pressure in patients with atrial fibrillation[J]. J Am Coll Cardiol，2018，72（11）：1233-1245.
[100] PARCHA V，PATEL N，KALRA R，et al. Incidence and implications of atrial fibrillation/flutter in hypertension：insights from the SPRINT trial[J]. Hypertension，2020，75（6）：1483-1490.
[101] PRANATA R，VANIA R，RAHARJO S B. Efficacy and safety of renal denervation in addition to pulmonary vein isolation for atrial fibrillation and hypertension-systematic review and meta-analysis of randomized controlled trials[J]. J Arrhythm，2020，36（3）：386-394.
[102] STEINBERG J B S，SHABANOV V，PONOMAREV D，et al. Effect of renal denervation and catheter ablation vs. catheter ablation alone on atrial fibrillation recurrence among patients with paroxysmal atrial fibrillation and hypertension：the ERADICATE-AF randomized clinical trial[J]. JAMA，2020，323（3）：248-255.
[103] TEH W H，SMITH C J，BARLAS R S，et al. Impact of stroke-associated pneumonia on mortality，length of hospitalization，and functional outcome[J]. Acta Neurol Scand，2018，138（4）：293-300.
[104] JI R J，SHEN H P，PAN Y S，et al. Risk score to predict hospital-acquired pneumonia after spontaneous intracerebral hemorrhage[J]. Stroke，2014，45（9）：2620-2628.
[105] 徐伟，李辉萍，宋治. 卒中并发下呼吸道感染的危险因素分析[J]. 中国卒中杂志，2008，3（4）：255-258.
XU W，LI H P，SONG Z. Risk factors analysis in stroke patients with lower respiratory tract infection[J]. Chin J Stroke，2008，3（4）：255-258.
[106] YU Y J，WENG W C，SU F C，et al. Association between pneumonia in acute stroke stage and 3-year mortality in patients with acute first-ever ischemic stroke[J/OL]. J Clin Neurosci，2016，33：124-128[2024-04-10]. https://doi.org/10.1016/j.jocn.2016.02.039.
[107] JI R J，WANG D，SHEN H P，et al. Interrelationship among common medical complications after acute stroke：pneumonia plays an important role[J]. Stroke，2013，44（12）：3436-3444.
[108] SMITH C J，BRAY B D，HOFFMAN A，et al. Can a novel clinical risk score improve pneumonia prediction in acute stroke care? A UK multicenter cohort study[J/OL]. J Am Heart Assoc，2015，4（1）：e1307[2024-04-10]. https://doi.org/10.1161/jaha.114.001307.
[109] JI R J，SHEN H P，PAN Y S，et al. Novel risk score to predict pneumonia after acute ischemic stroke[J]. Stroke，2013，44（5）：1303-1309.
[110] FAURA J，BUSTAMANTE A，MIRO-MUR F，et al. Stroke-induced immunosuppression：implications for the prevention and prediction of post-stroke infections[J/OL]. J Neuroinflammation，2021，18（1）：127[2024-04-10]. https://doi.org/10.1186/s12974-021-02177-0.
[111] SUI R B，ZHANG L. Risk factors of stroke-associated pneumonia in Chinese patients[J]. Neurol Res，2011，33（5）：508-513.
[112] ELTRINGHAM S A，KILNER K，GEE M，et al. Factors associated with risk of stroke-associated pneumonia in patients with dysphagia：a systematic review[J]. Dysphagia，2020，35（5）：735-744.
[113] ZHENG L，HUNTER K，GAUGHAN J，et al. Preadmission use of calcium channel blockers and outcomes after hospitalization with pneumonia：a retrospective propensity-matched cohort study[J/OL]. Am J Ther，2017，24（1）：e30-e38[2024-04-10]. https://doi.org/10.1097/mjt.0000000000000312.
[114] IKEDA J，KOJIMA N，SAEKI K，et al. Perindopril increases the swallowing reflex by inhibiting substance P degradation and tyrosine hydroxylase activation in a rat model of dysphagia[J]. Eur J Pharmacol，2015，746（7）：126-131.
[115] ARAI T，YOSHIMI N，FUJIWARA H，et al. Serum substance P concentrations and silent aspiration in elderly patients with stroke[J]. Neurology，2003，61（11）：1625-1626.
[116] YANG L，WENPING X，JINFENG Z，et al. Are beta blockers effective in preventing stroke-associated infections？—A systematic review and meta-analysis[J]. Aging（Albany NY），2022，14（10）：4459-4470.
[117]MAIER I L，BECKER J C，LEYHE J R，et al. Influence of beta-blocker therapy on the risk of infections and death in patients at high risk for stroke induced immunodepression[J/OL]. PLoS One，2018，13（4）：e196174[2024-04-10]. https://doi.org/10.1371/journal.pone.0196174.
[118]WILLIAMS B，MANCIA G，SPIERING W，et al. 2018 ESC/ESH guidelines for the management of arterial hypertension[J]. Eur Heart J，2018，39（33）：3021-3104.
[119] CAZZOLA M，NOSCHESE P，D’AMATO G，et al. The pharmacologic treatment of uncomplicated arterial hypertension in patients with airway dysfunction[J]. Chest，2002，121（1）：230-241.
[120] KAPLAN R C，TIRSCHWELL D L，LONGSTRETH WT，Jr，et al. Vascular events，mortality，and preventive therapy following ischemic stroke in the elderly[J]. Neurology，2005，65（6）：835842.
[121] WANG Z，CHEN Z，ZHANG L，et al. Status of hypertension in China：results from the China hypertension survey，2012—2015[J]. Circulation，2018，137（22）：2344-2356.
[122] DHAMOON M S，TAI W，BODENALBALA B，et al. Risk of myocardial infarction or vascular death after first ischemic stroke：the Northern Manhattan study[J]. Stroke，2007，38（6）：17521758.
[123] PATS Collaborating Group. Post‑stroke antihypertensive treatment study. A preliminary result[J]. Chin Med J，1995，108（9）：710‑717.
[124] KITAGAWA K，YAMAMOTO Y，ARIMA H，et al. Effect of standard vs. intensive blood pressure control on the risk of recurrent stroke：a randomized clinical trial and meta‑analysis[J]. JAMA Neurol，2019，76（11）：1309‑1318.
[125] MANT J，MCMANUS R J，ROALFE A，et al. Different systolic blood pressure targets for people with history of stroke or transient ischaemic attack：PAST‑BP（prevention after stroke‑blood pressure）randomised controlled trial[J/OL]. BMJ，2016，352：i708[2024-04-10]. https://doi.org/10.1136/bmj.i708.
[126] SPS3 Study Groupl. Blood‑pressure targets in patients with recent lacunar stroke：the SPS3 randomised trial[J]. Lancet，2013，382（9891）：507‑515.
[127] BATH P M，SCUTT P，BLACKBURN D J，et al. Intensive versus guideline blood pressure and lipid lowering in patients with previous stroke：main results from the pilot‘prevention of decline in cognition after stroke trial’（PODCAST）randomised controlled trial[J/OL]. PLoS One，2017，12（1）：e0164608[2024-04-10]. https://doi.org/10.1371/journal.pone.0164608.
[128] ZHANG W L，ZHANG S Y，DENG Y，et al. Trial of intensive blood‑pressure control in older patients with hypertension[J]. New Engl J Med，2021，385（14）：1268‑1279.
[129] LIU L S，WANG Z W，GONG L S，et al. Blood pressure reduction for the secondary prevention of stroke：a Chinese trial and a systematic review of the literature[J]. Hypertens Res，2009，32（11）：1032‑1040.
[130] WIYSONGE C S，BRADLEY H，MAYOSI B M，et al. Beta‑blockers for hypertension[J/OL]. Cochrane Database Syst Rev，2007（1）：Cd002003[2024-04-10]. https://doi.org/10.1002/14651858.CD002003.pub2.
[131] BANGALORE S，PARKAR S，GROSSMAN E，et al. A meta‑analysis of 94 492 patients with hypertension treated with beta blockers to determine the risk of new‑onset diabetes mellitus[J]. Am J Cardiol，2007，100（8）：1254‑1262.
[132] General Practitioners Branch of Chinese Medical Doctor’s Association. Expert consensus on the clinical application of sacubatrovalsartan sodium in cardiovascular diseases[J]. Chin Gen Prac，2021，24（23）：2885‑2890，2897.
[133] MC CAUSLAND F R，LEFKOWITZ M P，CLAGGETT B，et al. Angiotensin‑neprilysin inhibition and renal outcomes in heart failure with preserved ejection fraction[J]. Circulation，2020，142（13）：1236‑1245.
[134] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国脑血管病一级预防指南2019[J]. 中华神经科杂志，2019，52（9）：684-709.
Chinese Society of Neurology，Chinese Stroke Society. Guidelines for the primary prevention of cerebrovascular diseases in China 2019[J]. Chin J Neurol，2019，52（9）：684-709.
[135] LEWINGTON S，CLARKE R，QIZILBASH N，et al. Age-specific relevance of usual blood pressure to vascular mortality：a meta-analysis of individual data for one million adults in 61 prospective studies[J]. Lancet，2002，360（9349）：1903-1913.
[136] FEIGIN V L，ROTH G A，NAGHAVI M，et al. Global burden of stroke and risk factors in 188 countries，during 1990—2013：a systematic analysis for the global burden of disease study 2013[J]. Lancet Neurol，2016，15（9）：913-924.
[137] LACEY B，LEWINGTON S，CLARKE R，et al. Age-specific association between blood pressure and vascular and non-vascular chronic diseases in 0.5 million adults in China：a prospective cohort study[J/OL]. Lancet Glob Health，2018，6（6）：e641-e649[2024-04-10]. https://doi.org/10.1016/S2214-109X（18）30217-1.
[138] CHOBANIAN A V，BAKRIS G L，BLACK H R，et al. The seventh report of the Joint National Committee on Prevention，Detection，Evaluation，and Treatment of High Blood Pressure：the JNC 7 report[J]. JAMA，2003，289（19）：2560-2572.
[139] STRAZZULLO P，D’ELIA L，KANDALA N B，et. al. Salt intake，stroke，and cardiovascular disease：meta-analysis of prospective studies[J/OL]. BMJ，2009，339：b4567[2024-04-10]. https://doi.org/10.1136/bmj.b4567.
[140] 成丽娟，张述萍，刘芳，等. 不同干预措施预防正常高值血压人群发生高血压的效果［J］. 中华高血压杂志，2011，19（7）：652-657.
CHEN L J，ZHANG S P，LIU F，et al. The effect of different interventions to prevent hypertension in subjects with high-normal blood pressure[J]. Chin J Hypertens，2011，19（7）：652-657.
[141] SUN H X，CHEN S Y，JIANG B，et al. Public knowledge of stroke in Chinese urban residents：a community questionnaire study[J]. Neurol Res，2011，33（5）：536-540.
[142] LEE C D，FOLSOM AＲ，BLAIR S N. Physical activity and stroke risk：a meta-analysis[J]. Stroke，2003，34（10）：2475-2481.
[143] BRUNSTRÖM M，CARLBERG B. Association of blood pressure lowering with mortality and cardiovascular disease across blood pressure levels：a systematic review and meta-analysis[J]. JAMA Intern Med，2018，178（1）：28-36.
[144] CUSHMAN W C，EVANS G W，BYINGTON R P，et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus[J]. N Engl J Med，2010，362（17）：1575-1585.
[145] SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control[J]. N Engl J Med，2015，373（22）：2103-2116.
[146] XIE X F，ATKINS E，LV J C，et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes：updated systematic review and meta-analysis[J]. Lancet，2016，387（10017）：435-443.
[147] BROUWER T F，VEHMEIJER J T，KALKMAN D N，et al. Intensive blood pressure lowering in patients with and patients without type 2 diabetes：a pooled analysis from two randomized trials[J]. Diabetes Care，2018，41（6）：1142-1148.
[148] BEDDHU S，GREENE T，BOUCHER R，et al. Intensive systolic blood pressure control and incident chronic kidney disease in people with and without diabetes mellitus：secondary analyses of two randomised controlled trials[J]. Lancet Diabetes Endocrinol，2018，6（7）：555-563.
[149] World Health Organization. Guideline for the pharmacological treatment of hypertension in adults[EB/OL]. [2024-04-10]. https://www.ncbi.nlm.nih.gov/books/NBK573631/.
[150] ARNETT D K，BLUMENTHAL R S，ALBERT M A，et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease：executive summary：a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines[J]. J Am Coll Cardiol，2019，17（7）：577-579.
[151] PALMER S C，MAVRIDIS D，NAVARESE E，et al. Comparative efficacy and safety of blood pressure-lowering agents in adults with diabetes and kidney disease：a network meta-analysis[J]. Lancet，2015，385（9982）：2047-2056.
[152] LAW M R，MORRIS J K，WALD N J. Use of blood pressure lowering drugs in the prevention of cardiovascular disease：meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies[J/OL]. BMJ，2009，338：b1665[2024-04-10]. https://doi.org/10.1136/bmj.b1665.
[153] WU H Y，HUANG J W，LIN H J，et al. Comparative effectiveness of rennin-angiotensin system blockers and other antihypertensive drugs in patients with diabetes：systematic review and bayesian network meta-analysis[J/OL]. BMJ，2013，347：f6008[2024-04-10]. https://doi.org/10.1136/bmj.f6008.