脳卒中の1次，2次予防と血圧管理─高血圧治療ガイドラインJSH2009

For the prevention of cardiovascular events, especially stroke, strict blood pressure control is essential. In this review, recently published Japanese guidelines for treatment of hypertension is summarized, focusing on primary and secondary prevention of stroke. In the chronic phase of cerebrovascular disease (1 month or moreafter onset), the eventual target of blood pressure control should be <140/90mmHg. Blood pressure should be lowered carefully and slowly, paying attention to the stroke type such as cerebral hemorrhage, lacunar infarction, etc. The presence or absence of stenosis/obstruction of a main trunk of the cerebral arteries and the presence or absence of symptoms of cerebral circulatory insufficiency are also important. If the bilateral carotid arteries are markedly narrowed, or a main trunk of the cerebral arteries is obstructed, caution against an excessive decrease in blood pressure is necessary. A target of blood pressure control even lower than 140/90mmHg is recommended for patients with lacunar infarction or cerebral hemorrhage. Antihypertensive drugs recommended in the chronic phase of stroke are calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), diuretics, etc.