Research Advances in Blood Pressure Management during the Hyperacute Phase of Intracerebral Hemorrhage

doi:10.3969/j.issn.1673-5765.2025.07.004

Abstract

Abstract: Intracerebral hemorrhage is an acute cerebrovascular disease with high disability and mortality rates, as well as a heavy disease burden. Elevated blood pressure during the hyperacute phase of intracerebral hemorrhage is independently associated with hematoma expansion and poor prognosis. Current research shows that intensive blood pressure reduction targeting 130-140 mmHg (1 mmHg=0.133 kPa) within 6 hours of intracerebral hemorrhage onset is safe and effective. Earlier intervention correlates with better outcomes, particularly when intensive antihypertensive therapy is initiated within 2 hours during ambulance transport, which can significantly improve long-term prognosis. However, the safety and efficacy of blood pressure management strategies for specific patients, such as those with ultra-high systolic blood pressure (≥220 mmHg) or large volume hematoma, as well as the comparison and preferred schemes of different antihypertensive agents, still need further exploration. Additionally, promoting the prehospital management mode of intracerebral hemorrhage, as well as the early identification of prehospital intracerebral hemorrhage, remains a clinical challenge. Glial fibrillary acidic protein shows high diagnostic value as a potential biomarker, and the application of mobile stroke units can significantly shorten the time from ambulance dispatch to the first brain imaging scan, providing a new approach for hyperacute management. Future research should focus on blood pressure management in specific patients, such as those with large volume hematoma and ultra-high baseline systolic blood pressure, exploration of novel biomarkers, and improvement of the prehospital to in-hospital coordinated care systems to further enhance survival rates and prognosis in intracerebral hemorrhage patients.

Key words: Intracerebral hemorrhage; Hyperacute phase; Blood pressure management; Intensive blood pressure reduction; Prehospital emergency care

摘要： 脑出血是一种致残致死率高、疾病负担重的急性脑血管疾病，其超急性期血压升高与血肿扩大及不良预后独立相关。现有研究表明，脑出血发病6 h内以130～140 mmHg（1 mmHg=0.133 kPa）为目标进行强化降压治疗是安全、有效的，且降压干预越早，患者的预后越好，尤其在救护车上2 h内启动强化降压可显著改善患者的远期预后。然而，针对超高收缩压（≥220 mmHg）、超大体积血肿等特殊患者降压策略的安全性及有效性，以及不同降压药物的比较和优选方案，仍需进一步探索。此外，如何推广脑出血院前管理的救治模式，以及院前脑出血的早期识别仍是临床难点。胶质纤维酸性蛋白作为潜在的生物标志物具有较高的诊断价值，而移动卒中单元的应用可显著缩短从派遣救护车到首次脑影像扫描的时间，为超急性期管理提供了新方向。未来研究应聚焦于大体积血肿、超高基线收缩压等特殊患者的血压管理、新型生物标志物的探索，以及院前-院内协同救治体系的完善，以进一步提高脑出血患者的生存率并改善预后。

关键词: 脑出血; 超急性期; 血压管理; 强化降压; 院前急救

CLC Number:

R74
R459.7

YANG Ruotong, CHEN Chen, LIU Feifeng, LI Gang. Research Advances in Blood Pressure Management during the Hyperacute Phase of Intracerebral Hemorrhage[J]. Chinese Journal of Stroke, 2025, 20(7): 819-828.

杨若彤, 陈晨, 刘飞凤, 李刚. 脑出血超急性期血压管理的研究进展[J]. 中国卒中杂志, 2025, 20(7): 819-828.

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