Interview with Professor Dong Qiang: The background and significance of the release of "Shanghai Expert Recommendations for the Management of Blood Pressure Variability in Inpatients with Ischemic Stroke"

Guide to September 26, 2021, led by Shanghai Stroke Society, led by Professor Dong Qiang from Huashan Hospital Affiliated to Fudan University, and written by Professor Zhao Yuwu from the Sixth People's Hospital Affiliated to Shanghai Jiaotong University, "Management of Blood Pressure Variability in Inpatients with Ischemic Stroke in Shanghai "Expert Suggestions" (referred to as "Expert Suggestions" in the text) was released at the Pan-Yangtze River Delta Director Salon • Jiangsu Station of Neurological Diseases
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This recommendation is the first guideline that focuses on the blood pressure variability of hospitalized patients with ischemic stroke, provides detailed recommendations for blood pressure management of hospitalized patients with ischemic stroke, and is important for improving the prognosis of patients with ischemic stroke in China Meaning
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After the meeting, Yimaitong conducted a special interview with Professor Dong Qiang, and further explained the management and treatment of blood pressure variability in patients with ischemic stroke
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Expert profile Professor Dong Qiang, Shanghai Leading Talent, Shanghai Top Ten Public Health Worker, Director of Neurology Department, Huashan Hospital, Fudan University, Deputy Director, National Center for Neurological Diseases (Huashan), Deputy Director, Chinese Medical Association Neurology Branch, Vice Chairman, Chinese Stroke Society Chairman of the Shanghai Medical Association Neurology Committee, Chairman of the Neurologist Branch of the Shanghai Medical Doctor Association Director of the Shanghai Neurological Diseases Clinical Medicine Center, Director of the Shanghai Neurology Quality Control Center, Executive Vice President of the Shanghai Stroke Society Yi Mai Tong: Could you please talk about the background of drafting the "Shanghai Expert Recommendations for the Management of Blood Pressure Variability in Inpatients with Ischemic Stroke".
What is the clinical significance of this recommendation for blood pressure management in AIS patients? Professor Dong Qiang's blood pressure management for stroke patients has always been our quality control goal
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At present, 60%-70% of stroke patients will have increased blood pressure after acute stroke, or have a history of hypertension
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Therefore, this risk factor should be actively controlled, especially blood pressure management in the acute phase
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There are two issues here: one is blood pressure management in the acute phase, and the other is the risk of long-term blood pressure stroke after stroke in patients with previous hypertension
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It can be seen that blood pressure is a very important quality control indicator, and blood pressure management for acute hospital patients is a starting point
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The patient's blood pressure management during the acute hospitalization period will make a big difference in the future clinical outcome and prognosis
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We hope that this important risk factor can be controlled in the acute phase of stroke, and that patients will be given standardized management during the hospitalization phase.
Therefore, an expert consensus on the management of blood pressure variability in stroke inpatients has been introduced
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Yimaitong: Could you please talk about the significance of blood pressure variability (BPV) management for patients with ischemic stroke? Professor Dong Qiang At present, domestic and foreign guidelines have standardized the blood pressure management in primary prevention and secondary prevention of ischemic stroke, but the fluctuation of blood pressure in the acute phase and its control goals are not well standardized
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In fact, in addition to the level of blood pressure after a stroke, the changes in blood pressure during a certain stage will also affect the risk of stroke or recurrence of the patient in the future
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Up to now, in clinical practice, we do not have very good standardized measurement methods and clinical practical techniques for blood pressure variability
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At this stage, when talking about patients in the acute phase of hospitalization, they always say that blood pressure should be smoothly reduced, but what is the standard for smooth blood pressure? In fact, the volatility of blood pressure during hospitalization is reduced, and the variability and fluctuation of blood pressure during discharge follow-up are reduced, which may have a more important effect than a lower blood pressure value
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Therefore, in different research phases (for example, 3 months, half a year, or even longer), we have to see the changes in blood pressure during continuous monitoring
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In previous studies of people with hypertension, it was found that individuals with smaller blood pressure variability have significantly fewer cardiovascular and cerebrovascular events and cardiovascular deaths in the future
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China is a major country with stroke.
It is hoped that when stroke is the focus of the incident in the neurological field, the management of the risk factor of patients with hypertension will bring greater benefits to patients
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This is the significance of blood pressure variability in stroke patients or patients with cardiovascular and cerebrovascular events
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Yimaitong: What are the main measures to reduce BPV in patients with hypertension in clinical practice? Professor Dong Qiang's treatment of hypertension must first meet the standard, and second, choose long-acting preparations as much as possible, which can exert the antihypertensive effect for a longer time
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First, it is necessary to choose long-acting preparations, such as drugs that can work for 24 hours, and bring better blood pressure management effects than single short-acting drugs
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Second, it is not only necessary to control blood pressure for a long time, but also to reduce the overall target value, that is, reach the target
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It is generally believed in the current cardiovascular events that, as long as there are no side effects, low systolic and diastolic blood pressure can reduce cardiovascular end-point events, even in stroke patients
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There is only one exception.
In patients with more than 75% bilateral carotid artery stenosis, the systolic blood pressure cannot be too low in the management of acute blood pressure or in the management of secondary prevention, because it will bring about a decrease in perfusion
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But for ordinary patients, it is almost exactly the same as cardiovascular
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Therefore, it is necessary to choose long-acting preparations, and to meet the standards, that is, both long-acting and strong-acting
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There is still another question to be explored.
For example, if a patient is hospitalized for two or three weeks, and the blood pressure reaches the standard and stabilized in these two or three weeks, can the patient's compliance with medication in the future be determined? Can it predict that the event prevention effect of medication for a longer period of time in the future will be better? This is also another very important factor recommended by this expert.
It is the hope that the stroke center in Shanghai can promote the better use of stable and powerful antihypertensive drugs in the future; to find ways to manage blood pressure factors and reduce end-point events.
Seek clinically feasible technical testing methods and testing methods
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Yimaitong: What is the mechanism of action of the new antihypertensive drug sacubatril and valsartan in controlling BPV in ischemic stroke? What are the advantages in the treatment of ischemic stroke? Professor Dong Qiang is first of all the advantages of the drug structure itself.
The specific pharmacological molecular structure of sacubitril and valsartan enables it to control blood pressure with a long-term effect, which is in line with the above-mentioned choice of long-acting and strong-acting drugs.

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The mechanism of action of sacubitril and valsartan is different from traditional antihypertensive drugs, and it is a newer generation of antihypertensive drugs
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Although sacubitril and valsartan contain valsartan, valsartan is not only the original ARB preparation in the new drug composition, but also has an effect on natriuretic peptides
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Therefore, the new generation of sacubitril and valsartan is even stronger than other drugs in terms of the strength and stability of lowering blood pressure
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At the same time, sacubitril and valsartan was previously used as a medicine for treating heart failure in China, and it has a protective effect on the heart
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In addition, some studies have found that sacubitril and valsartan also have protective effects on kidney function and nerve tissue damage
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It is hoped that after the introduction of this expert’s recommendation, with the promotion of the Shanghai Stroke Center, we can see in the real world that early, strong and stable blood pressure reduction will bring better neurological outcome to patients with early stroke, and the heart or other kidney complications will be achieved.
Better control, so that patients' final cardiovascular end-point events and cardiovascular deaths are significantly reduced
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In short, the use of sacubitril and valsartan in stroke patients has the effect of protecting the heart, kidneys, and nerve functions while reducing blood pressure more smoothly and long-term
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It has given our clinicians new methods and new hopes.
It is hoped that this drug can be used earlier in the Chinese stroke population and explore the benefits of new mechanisms of action for lowering blood pressure earlier.
This is also the expert’s recommendation.
The purpose of the release is to change clinical practice in Shanghai so that patients can obtain more meaningful benefits
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In the next notice, Yimaitong also specially invited the chief writer of "Shanghai Expert Recommendations on the Management of Blood Pressure Variability in Inpatients with Ischemic Stroke" and Professor Zhao Yuwu from the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University to conduct an exclusive interview with regard to the management of blood pressure variability in inpatients with stroke.
What did Professor Zhao talk about? For details, please follow the tweets tomorrow~~Review of "Expert Suggestions"↓↓↓The first "Shanghai Expert Suggestions for Blood Pressure Management of Inpatients with Ischemic Stroke" is released today! First look