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Blood pressure should not be lowered before ischemic stroke treatment

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For the treatment of ischemic stroke, maintaining hypertension before reperfusion therapy can promote collateral circulation, and actively lowering blood pressure after reperfusion therapy can improve prognosis and reduce bleeding. The latest results of a team of physicians working with Professor Mark Parsons of Royal Melbourne Hospital, Australia, and Professor Dong Qiang of Huashan Hospital Affiliated to Fudan University, China National Center for Clinical Medicine of Geriatric Diseases (Huashan), Cheng Xin, were published online in the academic journal Neurological Yearbook recently.

Aiming at the research hotspot of "the optimal range of blood pressure control in the treatment of acute ischemic stroke", the research team conducted a long-term study using the global multi-mode CT image database of acute stroke, which was co-operated by China and Australia. It was found that baseline blood pressure after acute ischemic stroke attack was beneficial to improve collateral circulation, whereas baseline blood pressure might lead to infarction under the condition of reperfusion treatment. The dead volume was enlarged and the prognosis was poor. Thus, the team first proposed whether reperfusion was a modifier of blood pressure and prognosis. At the same time, this study also puts forward for the first time the importance of reasonably choosing the time point of lowering (or increasing) blood pressure in stroke treatment. Maintaining hypertension before reperfusion treatment can promote collateral circulation. Positive blood pressure lowering after reperfusion treatment can improve prognosis and reduce bleeding. That is to say, active blood pressure lowering needs reperfusion treatment. The results of this study provide important information for the design of interventional clinical trials.

Since 2011, Dong Qiang's team has been working with Mark Parsons to carry out the study. At present, more than 2000 stroke patients have been assessed and nearly 1,000 have been successfully treated.

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