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首页> 外文期刊>The Canadian Journal of Neurological Sciences: le Journal Canadien des Sciences Neurologiques >Blood pressure management in acute stroke: comparison of current guidelines with prescribing patterns.
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Blood pressure management in acute stroke: comparison of current guidelines with prescribing patterns.

机译：急性中风的血压管理：将当前指南与处方模式进行比较。

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OBJECTIVE: Current recommendations for treating elevated blood pressure (BP) in the acute stroke are based largely on expert opinion and vary with regard to treatment thresholds and choice of antihypertensive agents. In this study we investigate the influence of these recommendations by comparing the management of hypertension in acute stroke at a tertiary care hospital with current guidelines. METHOD: Retrospective chart review of patients admitted with acute stroke at The Ottawa Hospital-General Campus over six consecutive months. The use of antihypertensive medications (type, dose, routes of administration, BP recordings) in the first seven days after admission was noted. RESULTS: Transdermal nitroglycerin paste was the most commonly used antihypertensive agent. In contrast to the 15% reduction in BP over 24 hours recommended for lowering BP in hypertensive patients with ischemic stroke, nitroglycerin caused a >15% reduction of BP over the first 24 hours on 60% of the occasions used. Furthermore, despite concerns about sublingual nifedipine, this was the second most commonly prescribed agent. Surprisingly, the mean time to first BP measurement following initiation of antihypertensive therapy was 117 +/- 43 minutes in ischemic stroke and 88 +/- 89 minutes in hemorrhagic strokes. CONCLUSIONS: The current guidelines for management of acute poststroke hypertension appear to have little influence on prescribing patterns, leading to considerable variations in practice. Such variations, likely due to uncertainty caused by lack of evidence from randomised controlled trials, are intolerable as patients maybe submitted to nonstandardised, potentially harmful care such as inappropriate choice of antihypertensives and inadequate BP monitoring as observed in this study.
机译：目的：目前在急性卒中中治疗高血压（BP）的建议主要基于专家意见，并且在治疗阈值和选择降压药方面有所不同。在这项研究中，我们通过将三级医院的急性卒中高血压管理与当前指南进行比较，研究了这些建议的影响。方法：回顾性图表回顾了连续六个月在渥太华医院总校园接受急性卒中的患者。记录入院后的前7天使用了降压药（类型，剂量，给药途径，血压记录）。结果：透皮硝酸甘油糊剂是最常用的降压药。与高血压缺血性卒中患者建议在24小时内将BP降低15％相比，硝酸甘油在60％的情况下在前24小时内可使BP降低> 15％。此外，尽管担心舌下硝苯地平，这是第二种最常用的处方药。出人意料的是，开始降压治疗后，首次测量血压的平均时间在缺血性卒中为117 +/- 43分钟，出血性卒中为88 +/- 89分钟。结论：当前的急性中风后高血压管理指南似乎对处方方式影响不大，导致实践上存在很大差异。这种变化很可能是由于缺乏随机对照试验的证据而导致的不确定性所致，因为患者可能会接受非标准化的，可能有害的护理，例如，对降压药的选择不当以及在本研究中观察到的BP监测不足，因此是无法忍受的。

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