臨床神経学
Online ISSN : 1882-0654
Print ISSN : 0009-918X
ISSN-L : 0009-918X
7 脳出血―最新の内科的アプローチ
脳出血内科治療の最新知見:予防,治療としての血圧管理
古賀 政利豊田 一則
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ジャーナル フリー

2012 年 52 巻 11 号 p. 1110-1112

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Intracerebral hemorrhage (ICH) is a common stroke subtype in Japan. Hypertension is the leading cause. Perindopril Protection Against Recurrent Stroke Study (PROGRESS) revealed that blood pressure (BP) lowering could reduce stroke recurrence by 28% (ICH recurrence by 49%). The guideline for the management of hypertension (JSH2009) recommends BP control of ≤140/90mmHg for patients with prior stroke. BP is frequently elevated in acute ICH, although BP management strategy is controversial. The guideline from the American Stroke Association suggests if systolic BP (SBP) >180mmHg and there is no evidence of elevated intracranial pressure, then consider a modest reduction of BP. A nationwide survey revealed that SBP lowering to ≤160mmHg using intravenous nicardipine in acute ICH is a major strategy in Japan, and the safety was confirmed by a multicenter, prospective, observational study. Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT) and Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) showed the feasibility and safety of early rapid BP lowering to 140mmHg. INTERACT2 and ATACH II are the randomized trials to compare the guideline-based control (<180mmHg) and strict control (<140mmHg). We have just started to enroll patients to ATACH II from Japan on February 2012.

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© 2012 日本神経学会
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