We often hear about hypertension and are familiar with it, but many people have never heard of stroke.
1, hypertension and stroke “grudge”, what is the relationship between them?
High blood pressure is an important risk factor for stroke. High blood pressure can promote the development of cerebral atherosclerosis, and the formation of atherosclerotic plaque can cause narrowing or occlusion of the arterial lumen, resulting in cerebral infarction due to impaired blood supply to brain tissue; fragments of the plaque are dislodged and enter the cerebral artery along the blood flow, resulting in cerebral infarction.
Ischemic stroke
In addition, under the effect of long-term hypertension, the small cerebral arteries continue to contract, resulting in brittle and hardened vessel walls, which can easily rupture and cause cerebral hemorrhage if there is a sudden increase in vascular pressure.
Usually the stroke can be preceded by related symptomatic manifestations, which need to be recognized in time and then actively seek medical attention. For example
– Dizziness, especially a sudden feeling of vertigo, especially if it is different in nature from previous dizziness.
– Sudden numbness on one side of the face or arm or leg, or in some cases, numbness of the tongue or lips.
– Temporary slurred speech or poor speech.
– Weakness or inability to move the limbs.
– Headache that is different from usual.
– Sudden unexplained fall or fainting.
– Temporary loss of consciousness or sudden changes in personality and intelligence.
– Significant general weakness and limb weakness.
– Nausea and vomiting or fluctuations in blood pressure.
– Drowsiness throughout the day, in a drowsy state.
-Involuntary twitching of one or one of the limbs or a sudden feeling of double vision of things appearing in front of the eyes.
Dizziness and lightheadedness
If you are a hypertensive patient and you experience the above symptoms, you should be alert to the occurrence of stroke. If you have a stroke, you should go to the hospital for a medical checkup and receive reasonable treatment according to your condition.
2.How much should blood pressure be controlled in a stable stroke patient?
For patients with stable stroke, blood pressure greater than or equal to 140/90 mmHg should be initiated with the goal of lowering blood pressure to less than 140/90 mmHg.
Anti-hypertensive drug therapy can significantly reduce the risk of stroke recurrence by 22%.
Stable stroke patients should have a lowering target of less than 140/90 mmHg.
In patients with ischemic stroke or transient ischemic attack (TIA) due to atherosclerotic stenosis of large intracranial arteries with 70%-99% stenosis, the recommended blood pressure should be lowered to less than 140/90 mmHg.
For stroke or transient ischemic attack (TIA) due to low hemodynamic factors, the speed and magnitude of blood pressure lowering should be weighed against the patient’s tolerability and hemodynamic impact.
The selection of the type and dose of antihypertensive drugs and the target value of antihypertensive should be individualized, taking into account the drug, stroke characteristics and patient factors.
3. What should the blood pressure be controlled in acute stroke and how should it be treated?
In the case of acute ischemic stroke prepared for thrombolysis, blood pressure should be controlled below 180/110 mmHg.
Patients with elevated blood pressure within 24 hours after ischemic stroke should be treated with caution and should first be treated for tension and anxiety, pain, nausea and vomiting, and increased intracranial pressure.
If blood pressure is persistently elevated, with systolic blood pressure ≥ 200 mmHg or diastolic blood pressure ≥ 110 mmHg, or in patients with severe cardiac insufficiency, aortic coarctation, or hypertensive encephalopathy, antihypertensive therapy may be indicated. Intravenous drugs such as labetalol and nicardipine can be used, and drugs that cause a sharp drop in blood pressure should be avoided.
In case of acute cerebral hemorrhage, the patient’s blood pressure should be evaluated comprehensively and the cause of the elevated blood pressure should be analyzed before deciding whether to administer antihypertensive therapy according to the blood pressure.
When the systolic blood pressure is >220 mmHg, intravenous antihypertensive drugs should be actively used to lower blood pressure; when the systolic blood pressure is >180 mmHg, intravenous antihypertensive drugs can be used to control blood pressure, and 160/90 mmHg can be used as a reference target value for blood pressure lowering.
Early aggressive BP lowering is safe, but the effectiveness of improving prognosis needs to be further verified. During antihypertensive treatment, patients should also be closely monitored for changes in blood pressure and blood pressure monitoring should be performed every 5-15 minutes.
References
[1] China Hypertension Prevention and Treatment Guidelines Revision Committee, Hypertension Alliance (China, Chinese Medical Association, Cardiovascular Disease Branch, Chinese Physicians Association, et al. Chinese guidelines for the prevention and treatment of hypertension (2018 revised edition) [J]. Chinese Journal of Cardiovascular,2019,24(1):24-56.
[2]Yue A.L.,Yang J. Analysis of risk factors and nursing interventions for hypertension combined with stroke[J]. Nutritional health care guide,2019(11):128.