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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 Division Director of the Neurological Diseases Salon·Jiangsu Station
.
After the meeting, Yimaitong conducted an exclusive interview with Professor Zhao and gave further explanations on the management of blood pressure variability in patients with ischemic stroke
.
Expert profile Professor Zhao Yuwu, Doctor of Neurology, Chief Physician/Professor, Doctoral Supervisor
.
Director of Department of Neurology, The Sixth People's Hospital Affiliated to Shanghai Jiaotong University
.
Member of the Neurology Branch of the Chinese Medical Association, Deputy Chairman of the Immunology Branch of the Chinese Stroke Society, Member of the Neuroimmune Branch of the Chinese Immunological Society, Member of the Critical Cerebroemia Branch of the Chinese Stroke Society, Vice Chairman of the Neurology Branch of the Shanghai Medical Association, Shanghai Medical Doctors Association Vice President of the Branch of Neurologists, Vice Chairman of the Chronic Disease Management Committee of the Shanghai Medical Association, and Deputy Secretary-General of the Shanghai Stroke Society
.
The project leader has won 5 National Natural Science Foundation of China, and the first/corresponding author has published more than 100 papers
.
The first completer won 4 scientific and technological achievement awards
.
Yimaitong: Could you please introduce what is blood pressure variability (BPV)? What are the classifications of blood pressure variability? Professor Zhao Yuwu has complicated spontaneous fluctuations in human blood pressure within 24 hours.
This fluctuation is called blood pressure variability (BPV)
.
BPV exists in normal people or hypertensive patients
.
The difference is that normal people's BPV fluctuates within a physiological range under the blood pressure balance regulation mechanism, showing a dipper-shaped fluctuation curve; while in hypertensive patients, not only the average blood pressure rises, but the BPV also increases
.
There are many classification methods for BPV, which can be divided into physiological, pathological, and drug-induced mutations according to the cause of occurrence.
Pathological BPV includes: non-dipper blood pressure variation, anti-dipper blood pressure variation, and superdipper blood pressure variation , Nocturnal high blood pressure, morning peak blood pressure increase and early morning high blood pressure
.
According to the length of blood pressure monitoring, it can be divided into four types: ultra-short-term BPV: blood pressure variability between each heartbeat Short-term BPV: blood pressure variability within 24 hours Mid-term BPV: blood pressure variability for consecutive days or weeks Long-term BPV: months Blood pressure variability during long-term follow-up and Yimaitong: How to evaluate blood pressure variability (BPV) in clinical practice? Professor Zhao Yuwu’s clinical evaluation methods for BPV include office blood pressure, home self-test blood pressure and 24h ambulatory blood pressure monitoring, which are currently the most commonly used Several methods
.
Among them, office hypertension may have a white coat effect, and the measured blood pressure value may be higher than the true blood pressure level of hypertensive patients
.
However, whether it is the office blood pressure or the family self-measured blood pressure, what it reflects is only the blood pressure value at a specific point and moment; now a number of domestic and foreign expert consensus and guidelines recommend 24-hour ambulatory blood pressure monitoring.
This method It is more scientific and reliable to reflect the variability of blood pressure
.
The "2019 Asian Ambulatory Blood Pressure Monitoring HOPE Expert Consensus" pointed out that ambulatory blood pressure monitoring is currently the best method for diagnosing hypertension, and it is also the only method currently used to assess 24h blood pressure and BPV
.
"Shanghai Expert Recommendations for the Management of Blood Pressure Variability in Inpatients with Ischemic Stroke" recommends that ambulatory blood pressure monitoring is the preferred method for evaluating 24h blood pressure and BPV
.
It is recommended that all patients with ischemic stroke (regardless of hospitalization or outpatient follow-up) should have regular ambulatory blood pressure monitoring to exclude white coat hypertension and diagnose hidden hypertension; determine whether there is pathological BPV and its types; guide ischemic Blood pressure management in stroke patients
.
Yimaitong: "Shanghai Expert Recommendations on the Management of Blood Pressure Variability in Inpatients with Ischemic Stroke" for reducing BPV in patients with hypertension? How effective is the new antihypertensive drug sacuba and valsartan in reducing BPV? Professor Zhao Yuwu has two points to pay attention to in reducing BPV in patients with hypertension: one is to identify these patients from the monitoring method, and at the same time to clarify the type of BPV the patient belongs to; the other is how to choose antihypertensive drugs to lower blood pressure and at the same time To reduce the BPV of patients, the general principle is to use 24-hour long-acting and stable antihypertensive drugs
.
This "Expert Recommendation" recommends: In order to reduce the BPV of hypertensive patients and achieve the goal of good blood pressure control, it is recommended to use long-acting antihypertensive drugs and combination drugs, and adjust the blood pressure plan according to the results of ambulatory blood pressure monitoring
.
In terms of the mechanism of action, the new antihypertensive drug sacubitril and valsartan is aimed at the "fifth antihypertensive target"-the natriuretic peptide system
.
Relatively speaking, it is more suitable for our Asians with salt-sensitive hypertension.
A number of clinical studies have shown that sacubitril and valsartan have a stable blood pressure lowering effect and have a good blood pressure lowering effect
.
In addition, sacubitril and valsartan also have the effects of target organ protection
.
Yimaitong: What are the advantages of the new antihypertensive drug sacubati and valsartan for the control of BPV in patients with ischemic stroke? Professor Zhao Yuwu About 60% of acute ischemic stroke patients will be accompanied by cerebral-heart syndrome, and sacubitril and valsartan can protect the heart and lower blood pressure.
A drug expected in the treatment of acute blood pressure
.
At the same time, sacubitril and valsartan also has a 24-hour stable and strong antihypertensive effect.
It has a stable antihypertensive effect on nocturnal hypertension and early morning hypertension, making it unique in secondary stroke prevention.
.
In addition, sacubitril and valsartan also have the effects of regulating glucose metabolism and protecting kidney function.
Chronic kidney disease and diabetes are risk factors for stroke, and sacubitril and valsartan also increase the secondary prevention of stroke.
Advantage in
.
"Shanghai Expert Recommendations for the Management of Blood Pressure Variability in Inpatients with Ischemic Stroke" ➤Sakurabatril and Valsartan has the effects of multi-target organ protection and improvement of metabolic disorders.
It also has unique advantages in reducing nocturnal hypertension and reducing BPV in Asian patients
.
The use of sacubitril and valsartan is recommended in the secondary prevention of patients with ischemic stroke and hypertension
.
➤Sacubatril and Valsartan has a unique cardioprotective effect.
AIS patients are usually accompanied by various cardiac complications
.
It is recommended to use sacubitril and valsartan in patients with AIS with cardiac dysfunction and other cardiac complications, as well as AIS patients with antihypertensive treatment
.
Previous review↓↓↓Interview with Professor Dong Qiang: The background and significance of the release of "Shanghai Expert Recommendations on Blood Pressure Variability Management in Inpatients with Ischemic Stroke" The first "Shanghai Expert Recommendations on Blood Pressure Management in Inpatients with Ischemic Stroke" was released today! First look
.
After the meeting, Yimaitong conducted an exclusive interview with Professor Zhao and gave further explanations on the management of blood pressure variability in patients with ischemic stroke
.
Expert profile Professor Zhao Yuwu, Doctor of Neurology, Chief Physician/Professor, Doctoral Supervisor
.
Director of Department of Neurology, The Sixth People's Hospital Affiliated to Shanghai Jiaotong University
.
Member of the Neurology Branch of the Chinese Medical Association, Deputy Chairman of the Immunology Branch of the Chinese Stroke Society, Member of the Neuroimmune Branch of the Chinese Immunological Society, Member of the Critical Cerebroemia Branch of the Chinese Stroke Society, Vice Chairman of the Neurology Branch of the Shanghai Medical Association, Shanghai Medical Doctors Association Vice President of the Branch of Neurologists, Vice Chairman of the Chronic Disease Management Committee of the Shanghai Medical Association, and Deputy Secretary-General of the Shanghai Stroke Society
.
The project leader has won 5 National Natural Science Foundation of China, and the first/corresponding author has published more than 100 papers
.
The first completer won 4 scientific and technological achievement awards
.
Yimaitong: Could you please introduce what is blood pressure variability (BPV)? What are the classifications of blood pressure variability? Professor Zhao Yuwu has complicated spontaneous fluctuations in human blood pressure within 24 hours.
This fluctuation is called blood pressure variability (BPV)
.
BPV exists in normal people or hypertensive patients
.
The difference is that normal people's BPV fluctuates within a physiological range under the blood pressure balance regulation mechanism, showing a dipper-shaped fluctuation curve; while in hypertensive patients, not only the average blood pressure rises, but the BPV also increases
.
There are many classification methods for BPV, which can be divided into physiological, pathological, and drug-induced mutations according to the cause of occurrence.
Pathological BPV includes: non-dipper blood pressure variation, anti-dipper blood pressure variation, and superdipper blood pressure variation , Nocturnal high blood pressure, morning peak blood pressure increase and early morning high blood pressure
.
According to the length of blood pressure monitoring, it can be divided into four types: ultra-short-term BPV: blood pressure variability between each heartbeat Short-term BPV: blood pressure variability within 24 hours Mid-term BPV: blood pressure variability for consecutive days or weeks Long-term BPV: months Blood pressure variability during long-term follow-up and Yimaitong: How to evaluate blood pressure variability (BPV) in clinical practice? Professor Zhao Yuwu’s clinical evaluation methods for BPV include office blood pressure, home self-test blood pressure and 24h ambulatory blood pressure monitoring, which are currently the most commonly used Several methods
.
Among them, office hypertension may have a white coat effect, and the measured blood pressure value may be higher than the true blood pressure level of hypertensive patients
.
However, whether it is the office blood pressure or the family self-measured blood pressure, what it reflects is only the blood pressure value at a specific point and moment; now a number of domestic and foreign expert consensus and guidelines recommend 24-hour ambulatory blood pressure monitoring.
This method It is more scientific and reliable to reflect the variability of blood pressure
.
The "2019 Asian Ambulatory Blood Pressure Monitoring HOPE Expert Consensus" pointed out that ambulatory blood pressure monitoring is currently the best method for diagnosing hypertension, and it is also the only method currently used to assess 24h blood pressure and BPV
.
"Shanghai Expert Recommendations for the Management of Blood Pressure Variability in Inpatients with Ischemic Stroke" recommends that ambulatory blood pressure monitoring is the preferred method for evaluating 24h blood pressure and BPV
.
It is recommended that all patients with ischemic stroke (regardless of hospitalization or outpatient follow-up) should have regular ambulatory blood pressure monitoring to exclude white coat hypertension and diagnose hidden hypertension; determine whether there is pathological BPV and its types; guide ischemic Blood pressure management in stroke patients
.
Yimaitong: "Shanghai Expert Recommendations on the Management of Blood Pressure Variability in Inpatients with Ischemic Stroke" for reducing BPV in patients with hypertension? How effective is the new antihypertensive drug sacuba and valsartan in reducing BPV? Professor Zhao Yuwu has two points to pay attention to in reducing BPV in patients with hypertension: one is to identify these patients from the monitoring method, and at the same time to clarify the type of BPV the patient belongs to; the other is how to choose antihypertensive drugs to lower blood pressure and at the same time To reduce the BPV of patients, the general principle is to use 24-hour long-acting and stable antihypertensive drugs
.
This "Expert Recommendation" recommends: In order to reduce the BPV of hypertensive patients and achieve the goal of good blood pressure control, it is recommended to use long-acting antihypertensive drugs and combination drugs, and adjust the blood pressure plan according to the results of ambulatory blood pressure monitoring
.
In terms of the mechanism of action, the new antihypertensive drug sacubitril and valsartan is aimed at the "fifth antihypertensive target"-the natriuretic peptide system
.
Relatively speaking, it is more suitable for our Asians with salt-sensitive hypertension.
A number of clinical studies have shown that sacubitril and valsartan have a stable blood pressure lowering effect and have a good blood pressure lowering effect
.
In addition, sacubitril and valsartan also have the effects of target organ protection
.
Yimaitong: What are the advantages of the new antihypertensive drug sacubati and valsartan for the control of BPV in patients with ischemic stroke? Professor Zhao Yuwu About 60% of acute ischemic stroke patients will be accompanied by cerebral-heart syndrome, and sacubitril and valsartan can protect the heart and lower blood pressure.
A drug expected in the treatment of acute blood pressure
.
At the same time, sacubitril and valsartan also has a 24-hour stable and strong antihypertensive effect.
It has a stable antihypertensive effect on nocturnal hypertension and early morning hypertension, making it unique in secondary stroke prevention.
.
In addition, sacubitril and valsartan also have the effects of regulating glucose metabolism and protecting kidney function.
Chronic kidney disease and diabetes are risk factors for stroke, and sacubitril and valsartan also increase the secondary prevention of stroke.
Advantage in
.
"Shanghai Expert Recommendations for the Management of Blood Pressure Variability in Inpatients with Ischemic Stroke" ➤Sakurabatril and Valsartan has the effects of multi-target organ protection and improvement of metabolic disorders.
It also has unique advantages in reducing nocturnal hypertension and reducing BPV in Asian patients
.
The use of sacubitril and valsartan is recommended in the secondary prevention of patients with ischemic stroke and hypertension
.
➤Sacubatril and Valsartan has a unique cardioprotective effect.
AIS patients are usually accompanied by various cardiac complications
.
It is recommended to use sacubitril and valsartan in patients with AIS with cardiac dysfunction and other cardiac complications, as well as AIS patients with antihypertensive treatment
.
Previous review↓↓↓Interview with Professor Dong Qiang: The background and significance of the release of "Shanghai Expert Recommendations on Blood Pressure Variability Management in Inpatients with Ischemic Stroke" The first "Shanghai Expert Recommendations on Blood Pressure Management in Inpatients with Ischemic Stroke" was released today! First look
