<International Circulation>:So you think that aggressive lowering of blood pressure is recommended rather than a step wise approach?
 
   《 国际循环》： 所以您认为积极降压策略要优于循序降压的方式？

    Prof Carmelo Graffagnino:  Yes and the INTERACT phase 2 study which is in progress is addressing whether long term outcome are made better by aggressive reduction. We know from their phase 1 study that the hematoma volume seems to be stabilized. In our population with patients we treated very aggressively with a drug called clevidipine we showed that hematoma volume was almost completely arrested. These are two studies which show that early aggressive blood pressure reduction stabilizes bleeding. What needs to be determined is that translates into an outcome that is clinically significant. 
     卡梅洛教授：是的，正在进行的INTERACT 2期试验正在探讨积极降压是否有助于改善患者远期预后。1期试验已证实积极降压可稳定血肿体积。我们治疗的病例中，应用氯维地平（clevidipine）积极降压，几乎所有患者的血肿体积都得到完全控制。已有两项试验表明早期积极降压策略可有效控制出血，我们需要明确的是这种出血的控制能否转化为临床结局的显著改善。

    <International Circulation>: Is there a preference in terms of what antihypertensive agents you use 24 and 48 hours after the incident?
   《 国际循环》：  在发病24~48小时后，应如何选择降压药物？

    Prof Carmelo Graffagnino: In the acute phase you should always use antihypertensive agents that are short acting and titratable. You must also understand the pharmacological properties of the drugs to avoid any dangerous side effects such as increased cerebral perfusion. Sodium nitroprusside is one of the most popular drugs in the world but it causes cerebral vasodilation. In our practice after 24 - 48 hours we aim to switch patients to oral drugs in an effort to get them off intravenous agents which are both costly and require ICU (Intensive Care unit). The oral agents are chosen according to their co morbidities; if we have a diabetic patient we give them ACEI， if we have a patient with coronary artery disease we give them a beta blocker and if we have a patient with congestive heart or renal failure we may go for a vasodilating drug like nifedipine， hydralazine or diuretics. We know from studies done 10 years ago that diuretics are as effective as any drug， very inexpensive and is always in our first line of drugs we add to either with other drugs depending on the patient.
     卡梅洛教授：在急性期应选用可滴定的短效降压药物，同时必须了解所用药物的药理学特性以避免脑灌注增加等危险的副反应。硝普纳是最常用药物之一，但其可引起脑血管扩张。在临床实践中，发病24~48小时后我们力图将患者转为口服降压药物，而脱离费用高昂且需要重症监护的静脉药物治疗。口服降压药物的选择需考虑患者的合并症，我们给予糖尿病患者ACEI；对冠状动脉病变给予β受体阻滞剂；如患者合并充血性心力衰竭或肾功能衰竭，则给予尼非地平、肼苯哒嗪等扩血管药物或利尿剂。早在10年前的研究就已证实，利尿剂与其他任何药物降压疗效相当且价格低廉，一直作为我们控制血压的一线用药，并可根据患者情况联合其他降压药物。
 

 Professor Carmelo Graffagnino， Duke Health Institute，TISC 2010特邀讲者。