**2.2 The role of antihypertensive treatment in Moyamoya disease**

The Japanese guidelines for Moyamoya disease management recommend giving antihypertensive drugs to control blood pressure during the acute phase of intracranial hemorrhage for preventing hematoma expansion. However, the target blood pressure during the acute phase of intracranial hemorrhage is unclear. During the acute phase of intracranial hemorrhage in Moyamoya patients, the guidelines postulate that systolic and diastolic blood pressure should be under control below 180 and 105 mmHg, respectively, without any clinical evidence.

Comparing clinical outcomes between Moyamoya patients with and without hypertension in China shows that severe untreated hypertension is an independent risk factor for unfavorable outcomes [24]. Antihypertensive drugs could prevent patients with hypertension from unfavorable outcomes. Long term antihypertensive treatment is only for Moyamoya patients with hypertension. The target blood


**Table 1.**

*The role of antithrombotic treatment in Moyamoya disease.*


### **Table 2.**

*The role of antihypertensive treatment in Moyamoya disease.*


**Table 3.**

*The role of lipid-lowering therapy in Moyamoya disease.*

pressure for Moyamoya patients with chronic hypertension should refer to which recommended in standard guidelines for hypertension. The fisrt-line antihypertensive drugs recommended by the guidelines include Angiotensin-converting enzyme inhibitors, Angiotensin receptor blockers, Calcium channel blockers and Diuretics [25]. Routine use of antihypertensive drugs in Moyamoya patients without hypertension for primary hemorrhagic or ischemic prevention is not recommended [22]. **Table 2** shows the role of antihypertensive treatment in Moyamoya disease.
