<International Circulation>: Elevated blood pressure is common in the setting of acute stroke and the question of whether or not to lower blood pressure in ischemic stroke is one that we are interested in. What is your opinion on this topic and what do you think would be the proper target blood pressure for these acute stroke patients?

 《国际循环》：急性卒中时血压常升高，我们对缺血性卒中时是否需要降压的问题很感兴趣。对此您的观点是什么，您认为这些急性卒中患者合适的血压靶目标是什么？

    Prof.Kjeldsen: First of all， about 75% of people with acute stroke have elevated blood pressure. The problem has been that we have not really had intervention studies to see whether we should treat it or not. There have been some small pilot studies that have previously suggested that we might do some benefit including a study called ACCESS which was presented in Prague in 2002 and published in Stroke thereafter. Based on that， we actually set up a large randomized clinical trial in Oslo and randomized more than 2000 (ten times as many) patients to acute treatment with candesartan versus placebo. The fact is it emerges that there is absolutely no difference. There is even a small trend towards doing harm. The paper came out in the Lancet in February and that is what we have to discuss at this meeting – what to do next? Are there any openings for the treatment of blood pressure in acute stroke? It appears from the data at hand that there is a J-shaped curve whereby as the pressure comes down， the cardiovascular complications in fact increase. It is the same if blood pressure is going up during acute stroke; it is a bad prognostic sign. But if it is also too low it is also bad for the patients. The intervention didn’t achieve anything positive so basically that is the current situation – that we shouldn’t lower blood pressure in the acute phase of stroke.

    Kjeldsen教授：首先，约75%急性卒中患者血压升高。问题是我们并没有干预研究来指导是否需要降压。有些小型探索性研究曾证明降压可能有益，包括一个称为ACCESS的研究，2002年在布拉格提出，之后在Stroke上发表。基于此，我们在奥斯陆开始了一个大型随机临床试验，将2000多例患者（10倍之多）随机应用坎地沙坦 和安慰剂 进行急性期的治疗。结果显示2种治疗完全没有差异，甚至降压治疗显示出不利的趋势。文章在2月份的Lancet上发表，这也是我们在会上要讨论的——接下来要做什么？急性卒中时需要降压吗？从我们现有的数据看，降压治疗存在J形曲线，即随着血压的下降，心血管并发症实际上增加。急性卒中时如果血压上升也如此，这是预后差的标志。但是，如果血压太低，也对患者有害。干预没有获得任何阳性结果，事实如此—急性卒中时我们不应该降压。