Seminars in Cerebrovascular Diseases and Stroke最新文献_第10页

Hypertension and cerebrovascular disease 高血压和脑血管疾病

Seminars in Cerebrovascular Diseases and Stroke Pub Date : 2003-09-01 DOI: 10.1053/j.scds.2003.00.029

William J. Jones , Linda S. Williams , Askiel Bruno , José Biller

{"title":"Hypertension and cerebrovascular disease","authors":"William J. Jones , Linda S. Williams , Askiel Bruno , José Biller","doi":"10.1053/j.scds.2003.00.029","DOIUrl":"10.1053/j.scds.2003.00.029","url":null,"abstract":"<div><p>Stroke is a common problem in the United States and causes significant morbidity and mortality. In addition both the personal and economic costs of stroke are high. Chronic arterial hypertension is the most significant modifiable risk factor for stroke (ischemic and hemorrhagic), both because of it's high relative risk for stroke and also because of it's prevalence in the general population. In addition hypertension remains under-recognized and under-treated. Newer studies have demonstrated that more aggressive treatment of hypertension results in lower cardiovascular morbidity and mortality, including that due to stroke. Consequently, new definitions for hypertension and new recommendations for treatment have recently been published. Furthermore, certain conditions, such as stroke, have been determined to be a “compelling indication” for certain classes of antihypertension therapy. Chronic hypertension is an important cause of the vascular pathology which leads to stroke and intracerebral hemorrhage. Acute stroke and cerebral hemorrhage may also cause an acute rise in blood pressure. Treatment of elevated blood pressure during acute stroke must balance the theoretical risk of worsening the stroke due to reduced cerebral perfusion against the benefits of lowering blood pressure (reduced risk of hemorrhage, cerebral edema, and other end-organ damage). This has been made more challenging since the approval of thrombolytic therapy for acute ischemic stroke. Also, severely elevated blood pressure can also cause hypertensive encephalopathy which must be distinguished from stroke so that appropriate treatment can be instituted as quickly as possible.</p></div>","PeriodicalId":101154,"journal":{"name":"Seminars in Cerebrovascular Diseases and Stroke","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.scds.2003.00.029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57904078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 11

Ruptured anterior circulation cerebral aneurysm and occipital lobe infarction 脑前循环动脉瘤破裂及枕叶梗塞

Seminars in Cerebrovascular Diseases and Stroke Pub Date : 2003-09-01 DOI: 10.1053/j.scds.2003.00.058

Michael B. Pritz, Carl G. Bevering III

引用次数: 0

Antihypertensive treatment and prevention of stroke and dementia 抗高血压治疗和预防中风和痴呆

Seminars in Cerebrovascular Diseases and Stroke Pub Date : 2003-09-01 DOI: 10.1053/j.scds.2003.00.025

Ji-Guang Wang , Jan A. Staessen , Willem H. Birkenhäger

{"title":"Antihypertensive treatment and prevention of stroke and dementia","authors":"Ji-Guang Wang , Jan A. Staessen , Willem H. Birkenhäger","doi":"10.1053/j.scds.2003.00.025","DOIUrl":"10.1053/j.scds.2003.00.025","url":null,"abstract":"<div><p>Hypertension is the most consistent and powerful predictor of stroke and is involved in nearly 70% of strokes. Placebo-controlled trials have proven that blood-pressure-lowering treatment reduces the incidence of stroke by 40% in middle-aged or older hypertensive patients with predominantly diastolic hypertension and by 30% in older patients with isolated systolic hypertension. Recent trials have compared new agents (calcium-channel blockers, α-blockers, angiotensin converting enzyme inhibitors or angiotensin type-1 receptor blockers) with old durg classes (diuretics or β-blockers). Calcium-channel blockers, including (−8%, <em>P</em>=0.07) or excluding verapamil (−10%, <em>P</em>=0.02), as well as angiotensin type-1 receptor blockers (−24%, <em>P</em>=0.0002) resulted in better stroke prevention than did the old drugs, whereas the opposite trend was observed for angiotension converting enzyme inhibitors (+10%, <em>P</em>=0.03). An overview of 6 trials conducted in patients with a history of cerebrovascular disease demonstrated that antihypertensive drug treatment reduced stroke recurrence by 25% (<em>P</em>=0.004). A meta-regression analysis showed that within-trial differences in systolic blood pressure accounted for the prevention of stroke in most trials. In 5 trials, dementia was a secondary outcome. Overall, antihypertensive treatment did not reduce the incidence of vascular or degenerative dementia (−11%, <em>P</em>=0.15). However, when the analysis was limited to 3 trials involving a dihydropyridine or a diuretic as the mainstay of therapy, this benefit increased to 25% (<em>P</em>=0.01). Randomized clinical trials should urgently address the question to what extent blood-pressure-lowering therapy may prevent degenerative dementia.</p></div>","PeriodicalId":101154,"journal":{"name":"Seminars in Cerebrovascular Diseases and Stroke","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2003-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.scds.2003.00.025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74716707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 17

Blood Pressure, cerebrovascular disease, and stroke 血压、脑血管疾病和中风

Seminars in Cerebrovascular Diseases and Stroke Pub Date : 2003-09-01 DOI: 10.1053/S1528-9931(03)00048-7

MD Myron H. Weinberger (Guest Editor)

引用次数: 0

The prevention of secondary stroke, cardiac outcomes and cognitive decline in patients with cerebrovascular disease: The PROGRESS trial 预防脑血管疾病患者继发性脑卒中、心脏结局和认知能力下降:PROGRESS试验

Seminars in Cerebrovascular Diseases and Stroke Pub Date : 2003-09-01 DOI: 10.1053/j.scds.2003.00.027

Neil Chapman , John Chalmers

引用次数: 0

Health services research in cerebrovascular disease: The other translational research 脑血管疾病卫生服务研究:其他转化研究

Seminars in Cerebrovascular Diseases and Stroke Pub Date : 2003-06-01 DOI: 10.1053/scds.2003.0022

MD Linda S. Williams (Guest Editor)

引用次数: 0

Case report: Varicella zoster virus encephalitis with multifocal vasculopathy 病例报告:水痘带状疱疹病毒性脑炎伴多灶性血管病变

Seminars in Cerebrovascular Diseases and Stroke Pub Date : 2003-06-01 DOI: 10.1053/scds.2003.0023

Riley Snook, Karen L. Roos, Linda S. Williams

引用次数: 1

The epidemiology of stroke outcomes research: Illustration of an approach to outcomes methodology using racial/ethnic disparities in stroke 卒中结果研究的流行病学:卒中中使用种族/民族差异的结果方法学方法的说明

Seminars in Cerebrovascular Diseases and Stroke Pub Date : 2003-06-01 DOI: 10.1053/scds.2003.0015

Ronnie D. Horner

引用次数: 0

Health systems and physician behavior 卫生系统和医生行为

Seminars in Cerebrovascular Diseases and Stroke Pub Date : 2003-06-01 DOI: 10.1053/scds.2003.0016

Lawrence M. Brass

引用次数: 0

Case report: Endocarditis and multiple cerebral emboli 病例报告:心内膜炎合并多发性脑栓塞

Seminars in Cerebrovascular Diseases and Stroke Pub Date : 2003-06-01 DOI: 10.1053/scds.2003.0024

Juan Tejada, Linda S. Williams

引用次数: 0