International Circulation: At present which types of antihypertensive drugs have enough evidence to support its safety and efficacy in preventing secondary prevention of stroke in patients who have established cerebrovascular disease?  Which need more study?

国际循环：目前在已证实的哪种类型抗高血压药物的安全性和有效性可以用于脑血管疾病患者的二级预防？哪些药物仍需进一步的研究？

 

Prof. Kittner: Number one would be diuretics. Number two would be the combination of diuretics and ACE inhibitors. I think a more important question than what type of drug is what target blood pressure should be. Particularly I think it is not known what the target blood pressure should be for preventing stroke recurrence in China where there is a high proportion of patients who have symptomatic intracranial stenosis. Therefore， the target blood pressure for preventing recurrent stroke in this group may be different than the ideal target blood pressure in other patients. We just do not know.

Kittner教授：第一类是利尿剂。第二类是利尿剂和ACE抑制剂联合使用。我认为比哪种类型的药物更重要的是目标血压应控制在多少。特别是，我不知道在中国这样一个有着很高比率的症状性颅内动脉狭窄患者的国家预防卒中复发的目标血压是多少。因此，这组人群中预防卒中的目标血压不同于其他患者的理想目标血压。我们还不知道目标血压是多少。

International Circulation: Does the actual mechanism of blood pressure reduction protect more against stroke or is it the special properties or the particular drug?

国际循环：血压降低、特殊的作用或是某种药物是预防卒中二次发作的主要机制吗？

 

Prof. Kittner: At present there is not any clear evidence that the mechanism of blood pressure reduction contributes anything more than the amount of actual blood pressure reduction. If anything， there is more evidence for diuretic benefit rather than the newer and more expensive agents. Many special properties have been hypothesized but they have not been proven to be more advantageous in clinical trials.

Kittner教授：目前没有任何证据表明血压降低的机制比实际血压的降低值在预防卒中复发中更有效。如果有，利尿剂比新型及价格更贵的药物更有效。曾经假设过有多种特殊的作用，但在临床实验中并没有找到相关的证据。

International Circulation: Which stroke patients do you recommend undergo blood pressure lowering for secondary stroke prevention? Are there any subgroups of stroke patients who might not benefit from antihyerpertensive therapy?

国际循环：您推荐哪些卒中患者进行降压来作卒中的二级预防？有些亚组的卒中患者不会从抗高血压治疗中受益吗？

 

Prof. Kittner: All stroke patients should have blood pressure lowering， but it should not be in the acute period， it should be very gradual， and the amount of blood pressure reduction might be different for different patients. One should try to reduce blood pressure in all stroke patients but one must individualize the treatment. There may be some subgroups but we do not know who they are. Blood pressure reduction is so effective in preventing stroke that it is probably beneficial in all groups but what may change is the degree of blood pressure reduction. For example， someone with intracranial stenosis may not tolerate the same degree of blood pressure reduction as someone without intracranial stenosis. We do not know and that is why we must have a study that looks at different target blood pressure reductions in patients with different types of strokes. We have one for small subcortical strokes being conducted in the United States called the Secondary Prevention of Small Subcortical Strokes (SPS3) study but we do not have a study looking at different target blood pressure goals for intracranial stenosis.

Kittner教授：所有卒中患者均应进行降压治疗，但是不能在急性期进行，这应该是一个缓慢的过程，不同患者所应降低的血压值也不同。一方面所有卒中患者均应进行降压治疗，而另一方面治疗方案应个体化。可能有些亚组患者不能从降压治疗中受益，但是我们还不知道具体是哪些人群。降低血压是非常有效的预防卒中的手段，所有的人都可能从中受益，但是只是血压降低的幅度有所不同。比如，颅内动脉狭窄的患者就不能耐受无颅内动脉狭窄患者血压降低的幅度。我们不知道，同时这也是为什么我们必须研究不同类型卒中患者不同的血压降低幅度。在美国我们进行了一项小的皮质下卒中二级预防的研究称为小皮质下卒中的二级预防（SPS3）研究，但是我们没有关于颅内动脉狭窄不同降压目标的研究。

 

International Circulation: The results of the HOPE study and PROGRESS suggest that it is safe and effective to lower blood pressure in non-hypertensive patients with established cerebrovascular disease. Should neurologists advise patients with cerebrovascular disease and (nearly) normal blood pressures to use antihypertensive drugs for secondary prevention of stroke?

国际循环：HOPE和PROGRESS研究的结果表明，在有脑血管病的非高血压患者中降压治疗是安全有效的。神经内科医生应该建议脑血管病患者和（近期）血压正常的患者使用抗高血压药物来进行卒中的二级预防吗？

 

Prof. Kittner: Yes， I think the PROGRESS study clearly showed that patients without hypertension still benefited by having their blood pressure reduced.

 Kittner教授：是的，我认为PROGRESS研究明确的表明非高血压患者也会从血压降低中受益。