The number of hypertensive patients in China is large, and most of them have other diseases in combination, not in isolation. For patients with previous cerebrovascular diseases, how to manage blood pressure is a great concern for many patients with combined cerebrovascular diseases. This article will elaborate how to safely and effectively lower blood pressure in patients with combined cerebrovascular diseases with hypertension in China, taking into account the guidelines for hypertension. I. Classification and clinical manifestations of cerebrovascular disease Cerebrovascular disease, also known as stroke, includes ischemic stroke and hemorrhagic stroke, which occurs mostly in middle-aged and elderly patients with hypertension. Stroke is one of the leading causes of human death. The high morbidity, mortality and disability rates of stroke seriously affect society, family stability and the quality of life of patients, causing a heavy burden and great suffering to society and many families. The main symptoms of stroke include: hemiparesis, hemianesthesia, hemianopsia, aphasia; or crossed paralysis, crossed sensory disorder, external ophthalmoplegia, nystagmus, dysphagia, ataxia, vertigo; or limb weakness, numbness, sensory disorder of face, upper and lower limbs; unilateral limb movement inflexibility; speech impairment, poor speech; memory loss; sudden lack of clarity in seeing objects; or eye rotation Incontinence of urine; balance disorder, unstable standing; impaired consciousness; headache or nausea and vomiting; dizziness, tinnitus, etc. When the above symptoms appear, you should seek medical attention promptly. Second, hypertension combined with cerebrovascular disease antihypertensive strategy For patients with stroke combined with hypertension who are in stable condition, they should be treated with active conventional antihypertensive therapy. Patients with ischemic or hemorrhagic stroke, male or female, and any age should be given antihypertensive treatment. However, patients with severe bilateral carotid or intracranial artery stenosis and patients with severe postural hypotension should be treated with caution with antihypertensive therapy. Start with small doses of antihypertensive drugs, closely observe blood pressure levels and adverse reactions, and adjust antihypertensive drugs and their doses according to patient tolerance. If obvious adverse reactions such as dizziness occur, the dose should be reduced or antihypertensive drugs should be discontinued. Control blood pressure to a safe range (within 160/100mmHg) and eventually to 140/90mmHg, and intervene in a comprehensive manner to manage risk factors and coexisting clinical disorders, such as antiplatelet therapy, lipid-regulating therapy, glucose-lowering therapy, and arrhythmia management. Blood pressure should be controlled to <180/110 mmHg before thrombolysis in acute ischemic stroke.
Patients with elevated blood pressure within 24 hours of the onset of acute ischemic stroke should be managed with caution and should be treated first for stress and anxiety, pain, nausea and vomiting, and increased intracranial pressure. If systolic blood pressure is ≥200 mmHg
or diastolic blood pressure ≥110 mmHg, or with severe cardiac insufficiency, aortic coarctation, or hypertensive encephalopathy, the patient should be treated with antihypertensive therapy, such as labetalol or nicardipine, and closely observed.