International Circulation: Blood pressure reduction is the key point in reducing cardiovascular risks. So how low should we lower the blood pressure? Is “as low as possible” a good strategy?《国际循环》:降压是减低心血管风险的关键,血压应该降到多低?“尽可能低”是个好策略吗?
International Circulation: In acute stroke patients, what is your opinion about blood pressure control? Reducing blood pressure rapidly is a good idea or a bad one?
《国际循环》:对于急性中风患者的血压控制您有什么看法?快速降低血压是一个好主意还是坏主意?
Williams Louis: It depends what you mean by rapid. There are various ways of bringing the blood pressure down instantly but, when you do that sort of thing, it is difficult to control and often makes it possible to run into more problems. Even with server hypertension it is better to bring pressure down over 24, 48, or even 72 hours than it is to bring it down in 5 minutes. If you use very potent agents and drop it too quickly there are risks of renal complications, among others, if the systolic pressure falls too low. For a person who has just had a stroke, sometimes if you bring the pressure down too rapidly you may lose the patient. It is a different situation for a person who is recovering from a stroke and has high blood pressure. In these cases you should try, over a number of weeks, to normalize the blood pressure and achieve the targets. I think if you adopt that approach you avoid the immediate risks and maximize the long-term benefits.
Williams Louis: 这取决与您如何定义快速。有许多方法可以立刻降压。但一旦你开始,很难控制你可能遇到更多意想不到的问题。即使是很严重的高血压,24、48甚至72小时内将血压降下来比5分钟内将血压降下来好。如果你服用强效药迅速降压收缩压降的太低,有肾衰竭和其他并发症的风险。对于刚刚中风的患者,如果你降压太快,可能会失去这个病人。对于中风康复中的高血压患者,情况不同。在这种情况下,你应该尽量在几周内使血压达到正常达到既定目标。我认为如果你采取这种办法你能避免直接风险获得最大的长期受益。