高血压对脑卒中的影响及机制研究进展

doi:10.3969/j.issn.1674-490X.2026.02.008

摘要/Abstract

摘要： 脑卒中是中国成人致死、致残的首位病因。高血压作为一项重要但可控的危险因素,与脑卒中的关联成为公共卫生领域的研究重点。聚焦高血压对脑卒中的影响,系统阐述其流行病学、发病机制及治疗策略,旨在为高血压相关脑卒中的防治提供全面且深入的参考依据。

关键词: 高血压, 脑卒中, 发病机制, 流行病学

Abstract: Stroke is the leading cause of death and disability in China. Hypertension is an important but controllable risk factor, and its association with stroke has become the focus of research in the public health field. This study will focus on the impact of hypertension on stroke, and systematically elaborate its epidemiology, pathogenesis and treatment strategies, aiming to provide a comprehensive and in-depth reference for the prevention and treatment of hypertension-related stroke.

Key words: hypertension, stroke, pathogenesis, epidemiology

中图分类号:

王雅婷,郭梅芳,程美玉,赵佳鹤,贾慧卓. 高血压对脑卒中的影响及机制研究进展[J]. 医学研究与教育, 2026, 43(2): 58-69.

WANG Yating, GUO Meifang, CHENG Meiyu, ZHAO Jiahe, JIA Huizhuo. Advances on the influence and mechanism of hypertension on stroke[J]. Journal of Hebei Medical College for Continuing Education, 2026, 43(2): 58-69.

参考文献

[1] 《中国脑卒中防治报告》编写组.《中国脑卒中防治报告2019》概要[J].中国脑血管病杂志, 2020, 17(5): 272-281. DOI: 10.3969/j.issn.1672-5921.2020.05.008.
[2] FEIGIN V L, FOROUZANFAR M H, KRISHNAMURTHI R, et al. Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010[J]. Lancet, 2014, 383(9913): 245-254. DOI: 10.1016/s0140-6736(13)61953-4.
[3] QI W W, MA J, GUAN T J, et al. Risk factors for incident stroke and its subtypes in China: a prospective study[J]. J Am Heart Assoc, 2020, 9(21): e016352. DOI: 10.1161/JAHA.120.016352.
[4] 马丽媛,王增武,樊静,等.《中国心血管健康与疾病报告2021》要点解读[J].中国全科医学, 2022, 25(27): 3331-3346.DOI: 10.12114/j.issn.1007-9572.2022.0506.
[5] KARIO K, OKURA A, HOSHIDE S, et al. The WHO Global report 2023 on hypertension warning the emerging hypertension burden in globe and its treatment strategy[J]. Hypertens Res, 2024, 47(5): 1099-1102. DOI: 10.1038/s41440-024-01622-w.
[6] GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet Neurol,2021,20(10):795-820. DOI: 10.1016/S1474-4422(21)00252-0.
[7] FEIGIN V L, BRAININ M, NORRVING B, et al. World stroke organization:global stroke fact sheet 2025[J]. Int J Stroke, 2025,20(2):132-144. DOI: 10.1177/17474930241308142.
[8] GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016[J]. Lancet, 2017, 390(10100): 1151-1210. DOI: 10.1016/S0140-6736(17)32152-9.
[9] 《中国卒中中心报告》编写组. 《中国卒中中心报告2022》概要[J].中国脑血管病杂志, 2024, 21(8): 565-576. DOI: 10.3969/j.issn.1672-5921.2024.08.009.
[10] TU W J, ZHAO Z, YIN P, et al. Estimated burden of stroke in China in 2020[J]. JAMA Netw Open, 2023,6(3):e231455. DOI: 10.1001/jamanetworkopen.2023.1455.
[11] 李刘欣,朱辰蕊,林黎明,等.不同血压水平对青年人群早发脑卒中风险的影响[J].中华高血压杂志, 2022, 30(11): 1061-1068. DOI: 10.16439/j.issn.1673-7245.2022.11.013.
[12] 王文,马丽媛,何华.重视正常高值血压水平及其伴心血管危险因素者的干预[J].高血压杂志, 2005, 13(6): 329-331. DOI: 10.16439/j.cnki.1673-7245.2005.06.001.
[13] 卞延贺,周锐,张东峰.急性缺血性脑卒中患者复发的危险因素分析[J].精准医学杂志, 2025, 40(4): 358-361. DOI: 10.13362/j.jpmed.202540057.
[14] ALIQUE M, LUNA C, CARRACEDO J, et al. LDL biochemical modifications: a link between atherosclerosis and aging[J]. Food Nutr Res, 2015, 59(1): 29240. DOI: 10.3402/fnr.v59.29240.
[15] CHISTIAKOV D A, MELNICHENKO A A, MYASOEDOVA V A, et al. Mechanisms of foam cell formation in atherosclerosis[J]. J Mol Med(Berl), 2017, 95(11): 1153-1165. DOI: 10.1007/s00109-017-1575-8.
[16] 于紫涵,杨玲,汪拂宇,等.全身炎症反应指数和全身免疫炎症指数对老年前循环大血管闭塞血管内治疗无效再通的预测价值[J].临床医学研究与实践, 2025, 10(17): 53-56. DOI: 10.19347/j.cnki.2096-1413.202517013.
[17] 王贺.全身炎症反应指数与青年急性缺血性脑卒中相关性的研究[D]. 石家庄: 河北医科大学, 2024:1-40.
[18] 杨兴丹,王秋丽,李国锋,等.缺血性脑卒中患者颈动脉钙化影响因素的列线图模型构建及验证[J].中国动脉硬化杂志, 2024, 32(1): 40-48. DOI: 10.20039/j.cnki.1007-3949.2024.01.006.
[19] NORDBORG C, FREDRIKSSON K, JOHANSSON B B. The morphometry of consecutive segments in cerebral arteries of normotensive and spontaneously hypertensive rats[J]. Stroke, 1985, 16(2): 313-320. DOI: 10.1161/01.str.16.2.313.
[20] 陈士谟.出血性脑血管病的临床进展[J].黑龙江医药, 1982, 6(6): 27-31.
[21] 刘卫东.高血压性脑出血的诊治进展[J].上海医学, 2017, 40(11): 646-649.
[22] 冯伟,张明.青少年高血压前期血液动力学的临床研究[J].实用中医内科杂志,2010,24(2):54-55.DOI: 10.3969/j.issn.1671-7813.2010.02.30.
[23] 瞿凯,邱菊辉,王贵学.血管内皮细胞屏障功能的血流动力学调控及其与动脉粥样硬化的关系[J].中国动脉硬化杂志, 2020, 28(1): 1-6. DOI: 10.3969/j.issn.1007-3949.2020.01.002.
[24] 王茜,吕芳艳,李保应,等.中老年高血压病与高血压前期患者血流动力学变化的临床研究[J].山东大学学报(医学版),2011, 49(9): 68-70.
[25] DICKHOUT J G, COLGAN S M, LHOTAÁK S, et al. Increased endoplasmic reticulum stress in atherosclerotic plaques associated with acute coronary syndrome: a balancing act between plaque stability and rupture[J]. Circulation, 2007, 116(11): 1214-1216. DOI: 10.1161/CIRCULATIONAHA.107.728378.
[26] STONE P H, MAEHARA A, COSKUN A U, et al. Role of low endothelial shear stress and plaque characteristics in the prediction of nonculprit major adverse cardiac events:the PROSPECT study[J]. JACC Cardiovasc Imaging, 2018, 11(3): 462-471. DOI: 10.1016/j.jcmg.2017.01.031.
[27] 刘嘉欣.动态脑血流自动调节功能受损与脑白质高信号的相关性研究[D].大连:大连医科大学, 2022:1-37.
[28] CIPOLLA M J, LIEBESKIND D S, CHAN S L. The importance of comorbidities in ischemic stroke: impact of hypertension on the cerebral circulation[J]. J Cereb Blood Flow Metab, 2018, 38(12): 2129-2149. DOI: 10.1177/0271678X18800589.
[29] 吴春波,朱继红,孙宁玲.原发性高血压伴急性脑血管病凝血纤溶异常的研究[J].高血压杂志, 2000, 8(3): 217-218.
[30] 中国高血压防治指南修订委员会,高血压联盟(中国),中国医疗保健国际交流促进会高血压分会,等. 中国高血压防治指南(2024年修订版)[J]. 中华高血压杂志, 2024, 32(7): 603-700. DOI: 10.16439/j.issn.1673-7245.2024.07.002.
[31] 熊文翠,胡晓飞,汤雪红. 检测妊娠期高血压疾病、妊娠期糖尿病患者凝血功能指标的临床意义[J].中国妇幼保健, 2020, 35(9): 1643-1646. DOI: 10.19829/j.zgfybj.issn.1001-4411.2020.09.023.
[32] 陈絮,黄映贞,黄雪惠.凝血功能联合胎儿脐血流监测在妊娠期高血压疾病中的价值研究[J].中国计划生育和妇产科, 2019, 11(3): 53-56. DOI: 10.3969/j.issn.1674-4020.2019.03.14.
[33] SPRIGG N, GRAY L J, BATH P M, et al. Relationship between outcome and baseline blood pressure and other haemodynamic measures in acute ischaemic stroke: data from the TAIST trial[J]. J Hypertens, 2006, 24(7): 1413-1417. DOI: 10.1097/01.hjh.0000234123.55895.12.
[34] 高靖,王秀艳,杨红梅,等.急性缺血性脑卒中患者血清SDF-1、UCH-L1水平变化及其与病情程度和预后的关系[J].山东医药, 2021, 61(25): 46-48. DOI: 10.3969/j.issn.1002-266X.2021.25.011.
[35] 李琳,杨晓凤,周博,等.急性缺血性脑卒中不同水平血压管理应用效果及其对近期预后及认知功能的影响[J].现代生物医学进展, 2023, 23(22): 4267-4271. DOI: 10.13241/j.cnki.pmb.2023.22.013.
[36] HE J, ZHANG Y H, XU T, et al. Effects of immediate blood pressure reduction on death and major disability in patients with acute ischemic stroke: the CATIS randomized clinical trial[J]. JAMA, 2014, 311(5): 479-489. DOI: 10.1001/jama.2013.282543.
[37] 王增武,王圣,冯彩霞,等.中国卒中患者高血压管理专家共识[J].中国卒中杂志, 2024, 19(6): 672-698.
[38] 郭昕.出血性脑卒中后血压及其控制对预后的影响研究[D].长春:吉林大学, 2018:1-46.
[39] WANG W Z, WANG D, LIU H M, et al. Trend of declining stroke mortality in China: reasons and analysis[J]. Stroke Vasc Neurol, 2017, 2(3): 132-139. DOI: 10.1136/svn-2017-000098.
[40] RASHID P, LEONARDI-BEE J, BATH P. Blood pressure reduction and secondary prevention of stroke and other vascular events: a systematic review[J]. Stroke, 2003,34(11):2741-2748. DOI: 10.1161/01.STR.0000092488.40085.15.
[41] 王志敬,周吴刚,张立娟,等.脑卒中再发与高血压的关系及其干预状况的调查分析[J].慢性病学杂志, 2017, 18(2): 122-126. DOI: 10.16440/j.cnki.1674-8166.2017.02.002.
[42] ZONNEVELD T P, RICHARD E, VERGOUWEN M D, et al. Blood pressure-lowering treatment for preventing recurrent stroke, major vascular events, and dementia in patients with a history of stroke or transient ischaemic attack[J]. Cochrane Database Syst Rev, 2018, 7(7): CD007858. DOI: 10.1002/14651858.CD007858.pub2.
[43] MAEDA T, OHYA Y, ISHIDA S, et al. Optimal blood pressure target for patients with prior stroke: a systematic review and meta-analysis[J]. Hypertens Res, 2025, 48(6): 1859-1869. DOI: 10.1038/s41440-025-02183-2.
[44] 张伟丽,蔡军,张舒媛.老年高血压管理的新认识:从SPRINT研究到STEP研究[J].中国循环杂志, 2022, 37(2): 105-107. DOI: 10.3969/j.issn.1000-3614.2022.02.001.
[45] 曾学寨,刘德平.《2024年ESC血压升高和高血压管理指南》解读[J].中国心血管杂志,2024,29(5):400-403. DOI: 10.3969/j.issn.1007-5410.2024.05.003.
[46] 国家心血管病中心国家基本公共卫生服务项目基层高血压管理办公室,国家基层高血压管理专家委员会. 国家基层高血压防治管理指南2025版[J].中华心血管病杂志, 2025, 53(9): 977-991. DOI: 10.3760/cma.j.cn112148-20250401-00234.
[47] 林丽,宋姣,董碧蓉.高血压患者的营养管理[J].中国临床保健杂志, 2025, 28(3): 322-325. DOI: 10.3969/J.issn.1672-6790.2025.03.007.
[48] NEAL B, WU Y F, FENG X X, et al. Effect of salt substitution on cardiovascular events and death[J]. N Engl J Med, 2021, 385(12): 1067-1077. DOI: 10.1056/nejmoa2105675.
[49] APPEL L J, MOORE T J, OBARZANEK E, et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group[J]. N Engl J Med, 1997, 336(16): 1117-1124. DOI: 10.1056/NEJM199704173361601.
[50] NACI H, SALCHER-KONRAD M, DIAS S, et al. How does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication effects on systolic blood pressure[J]. Br J Sports Med, 2019, 53(14): 859-869. DOI: 10.1136/bjsports-2018-099921.
[51] 胡红娟,尹闺阁,匡泽民,等.不同运动方式对高血压患者心肺功能的影响研究进展[J].中国动脉硬化杂志, 2023, 31(11): 989-994, 1006. DOI: 10.20039/j.cnki.1007-3949.2023.11.009.
[52] 沈灵芝,何志鹏,章顺安,等.运动训练对高血压影响的研究进展[J].中华全科医师杂志, 2021, 20(10): 1095-1099. DOI: 10.3760/cma.j.cn114798-20210104-00006.
[53] 郭建君,郭航远,池菊芳, 等. 吸烟对心血管疾病的影响及最新进展[J].中国全科医学, 2017, 20(27): 3328-3331. DOI: 10.3969/j.issn.1007-9572.2017.00.034.
[54] MILLWOOD I Y, WALTERS R G, MEI X W, et al. Conventional and genetic evidence on alcohol and vascular disease aetiology: a prospective study of 500 000 men and women in China[J]. Lancet, 2019,393(10183):1831-1842. DOI: 10.1016/S0140-6736(18)31772-0.
[55] 中国卒中学会,《中国卒中学会急性缺血性卒中再灌注治疗指南》编写组.中国卒中学会急性缺血性卒中再灌注治疗指南2024[J].中国卒中杂志, 2024, 19(12): 1460-1478. DOI: 10.3969/j.issn.1673-5765.2024.12.014.
[56] 国家卫生健康委脑卒中防治工程委员会, 中华医学会神经外科学分会神经介入学组, 中华医学会放射学分会介入学组, 等.急性大血管闭塞性缺血性卒中血管内治疗中国专家共识(2019年修订版)[J].中华神经外科杂志,2019, 35(9): 868-879. DOI: 10.3760/cma.j.issn.1001-2346.2019.09.002.
[57] 郑可闯, 汪子文, 袁龙涛. DSA引导下神经介入机械取栓术联合rt-PA溶栓对缺血性脑卒中患者的治疗效果[J]. 中国医学工程, 2025, 33(10): 66-70. DOI: 10.19338/j.issn.1672-2019.2025.10.012.
[58] 秦冰,林银瑶,陆正齐.多学科协作模式改变缺血性卒中超早期重组组织型纤溶酶原激活剂静脉溶栓的预后[J].中国动脉硬化杂志, 2018, 26(1): 46-50.
[59] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国脑出血诊治指南(2019)[J].中华神经科杂志, 2019, 52(12): 994-1005. DOI: 10.3760/cma.j.issn.1006-7876.2019.12.003.
[60] MOULLAALI T J, WANG X, SANDSET E C, et al. Early lowering of blood pressure after acute intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data[J]. J Neurol Neurosurg Psychiatry, 2022, 93(1): 6-13. DOI: 10.1136/jnnp-2021-327195.
[61] WANG X, ARIMA H, YANG J, et al. Mannitol and outcome in intracerebral hemorrhage: propensity score and multivariable intensive blood pressure reduction in acute cerebral hemorrhage trial 2 results[J]. Stroke, 2015, 46(10): 2762-2767. DOI: 10.1161/STROKEAHA.115.009357.
[62] YADAV Y R, MUKERJI G, SHENOY R, et al. Endoscopic management of hypertensive intraventricular haemorrhage with obstructive hydrocephalus[J]. BMC Neurol, 2007,7(1):1. DOI: 10.1186/1471-2377-7-1.
[63] 翁荔华.多学科合作下分层急救护理团队在急性出血性脑卒中患者急救中的应用[J/OL].山西卫生健康职业学院学报, 2025: 1-4.(2025-11-17). https://doi.org/10.20281/j.cnki.wjyxb.000233.
[64] 邓天芳,邵世蓉,陈敏,等.多学科合作管理模式对出血性脑卒中术后患者生活质量的影响[J].中国社区医师, 2021, 37(29): 184-185.