[Impact of antihypertensive therapy on clinical status and quality of life in patients with initial manifestations of hypertensive encephalopathy].

AIM: To study the clinical and instrumental characteristics of hypertensive encephalopathy (HE) in early stages, as well as the time course of their changes during long-term antihypertensive therapy (AHT). SUBJECTS AND METHODS: Prior to and after 9-month AHT, 57 patients aged 50-70 years who had uncomplicated grades 1-2 arterial hypertension (AH) with grades I-II HE underwent comprehensive examination comprising the studies of cognitive functions, quality of life (QL), hemorheology, and hemostasis, duplex scanning of great and intracerebral vessels, echocardiography, 24-hour blood pressure monitoring, magnetic resonance imaging. RESULTS: Early-stage HE was characterized by more cerebral complaints, higher rates of hypertensive crises, a greater degree of psychoautonomic syndrome, and worse QL. Focal brain lesions were detected in 74%; left ventricular hypertrophy (LVH) was diagnosed in 61% of cases. All the patients were observed to have cognitive dysfunctions. AHT (amlodipine, lisinopril) produced a good antihypertensive effect and substantial improvements of the patients' cognitive functions, health status, and QL. LVH regression was achieved. CONCLUSION: HE is a clinical manifestation of damage to the brain as the principal target organ in AH and should be therefore kept in mind in estimating the cardiovascular risk. The diagnosis of HE requires the use of tests to evaluate cognitive functions.

[Acute disorders of cerebral circulation: prognostic factors in essential hypertension].

AIM: To study subclinical signs of cerebrovascular pathology as prognostic factors of development of acute disorders of cerebral circulation (ADCC) in essential hypertension (EH). MATERIAL AND METHODS: A prospective (10-13 years) cohort trial of prognostic significance of subclinical forms of cerebral pathology in EH in relation to ADCC development covered 111 men aged 45-55 years who had undergone a unified neurological and cardiological examination in 1992-1993. RESULTS: Such factors as disordered circulation along major arteries of the head (a relative risk 3.1 [1.2; 10.3]), thick intima-media complex of the common carotid artery (a relative risk: 5.2 [2.1; 14.3]), the presence of asymptomatic lacunar brain infarctions (a relative risk: 6.6 [2.3; 13.5]) were revealed to be of unfavourable prognostic significance in respect to development of ADCC in EH. CONCLUSION: Some subclinical risk factors may have prognostic value in relation to development of ADCC in EH.

[Epidemiology, clinical features and betaserc therapy of vertigo in initial and reversible cerebrovascular pathology].

The study comprised two sections: epidemiologic and clinical. The aim of the epidemiologic investigation was to determine prevalence of vertigo, including its mild cases, in patients with initial and reversible forms of cerebrovascular pathology. While screening an open population, 726 men and women aged 35-60 years have been examined using uniform program. Vertigo was detected in 30%, frequent and long-lasting one in 14.6% cases (8.1% men and 21.9% women, p < 0.001). A clinical section included a profound examination of 40 patients. Along with duplex scanning of major brain arteries, neurologic and otoneurologic examination of the patients, aucoustic stem evoked potentials have been registered. Marked dysfunctions of autonomic nervous system and changes in functioning of different vestibular analyzer regions were revealed. High efficacy of betaserk used during 2 months in dosage 16 mg three times a day was demonstrated by improvement of the patient's state in 97% cases.

[The wavelet analysis at heliobiological connections]. / Veivlet-analiz v geliobiotropnykh sviaziakh.

The Wavelet analysis of the time series of the number of insults per day and the variations of heliogeophysical indices was carried out. The patterns of Wavelet coefficients for both processes show a complex nonstationary behavior and the presence of periodic and acyclic constituents on different scales. During heliogeophysipal disturbances, the energy contribution to the processes increases more than threefold compared with the mean value on scales from three to five days.

[Prognostic value of the degree of night decrease of systolic pressure in patients with mild and moderate forms of hypertension (7-9-year prospective study)]. / Prognosticheskaia tsennost' stepeni nochnogo snizheniia sistolicheskogo arterial'nogo davleniia u bol'nykh s miagkoi i umerennoi formami gipertonicheskoi bolezni (7-9-letnee prospektivnoe nabliudenie).

AIM: To study a relationship between a carcadian blood pressure (BP) rhythm and cardiovascular events (CE) during 7-9 year follow-up in males with mild to moderate essential hypertension (EH). MATERIAL AND METHODS: 50 males (mean age 48.6 +/- 0.7 years) with mild to moderate EH were prospectively followed up for 7-9 years (8.4 +/- 0.1 years). We analysed 24-h BP recordings and protocol of echocardiography performed during the first hospitalization. The patients were divided into three groups: group 1 (n = 18) with normal (10-20%) nocturnal fall of systolic BP (NF SBP) and normal left ventricular mass index (LVMI < 125 g/m2); group 2 (n = 16) with insufficient (< 10%) NF SBP and normal LVMI; group 3 (n = 16) with LVMI > 125 g/m2. In these groups we assessed the prevalence of CE: myocardial infarction (MI), stroke (S), sudden death (SD), new cases of angina pectoris (AP), transient cerebral ischemic attack (TIA). RESULTS: No significant differences were found between the groups by mean age, body mass index, duration of arterial hypertension, mean 24-h and awake systolic and diastolic BP while significant differences were by nighttime BP profile parameters. During the follow-up 16 CE in 12 patients were documented (3 fatal and 13 nonfatal). In group 1 CE were observed in 1 patient (twice MI), in group 2-7 cases of CE (1 S, 1 TCIA, 2 MI, 2 AP) in 6 patients, in group 3-7 cases (2 MI, 3 TIA, 2 AP) in 5 patients, 3 of them were fatal. CONCLUSION: Insufficient nocturnal fall of SBP (< 10%) is an adverse prognostic factor for cardiovascular morbidity in mild to moderate essential male hypertensives.

[Hypertension--main risk factor of stroke. Results of a three years register in Krasnodar]. / Arterial'naia gipertoniia--osnovnoi faktor riska insul'ta (itogi 3 let provedeniia registra v Krasnodare).

Incidence of first stroke and stroke mortality in Krasnodar in 1997-2000 were higher compared with data of similar registers in Moskva and Novosibirsk. Hospitalization rate of patients with stroke especially of those with severe stroke was low with high 28 days and 1 year mortality. Main risk factor of stroke was hypertension which in about 2 thirds of patients was classified as mild. Half of the patients with hypertension had history of hypertensive crises. Despite high level of awareness about presence of hypertension only every tenth patient received regular antihypertensive therapy which however in most cases was ineffective. One half of the patients received no antihypertensive treatment at all. Even after stroke most of the patients did not take antihypertensive drugs and antiaggregants. Results of the register show that there exists a great deal of resource for implementation of standard measures aimed at primary and secondary stroke prevention and lowering of mortality of patients with stroke.

[Drug methods of preventing stroke in cardiovascular diseases (a lecture)]. / Medikamentoznye metody profilaktiki insul'ta pri serdechno-sosudistykh zabolevaniiakh (lektsiia).

Basing on the results of numerous investigations it is possible to single out 4 main directions in prevention of acute failure of cerebral circulation (AFCC) in cardiovascular diseases: stroke prevention in hypertensive subjects, prevention of cardioembolic stroke in patients with cardiac arrhythmia, prevention of recurrent AFCC episodes in patients with transitory ischemic attacks and minor stroke, prevention of the stroke by inhibition of progression of carotid atherosclerosis. The best population effect in stroke prevention belongs to active detection and adequate treatment of AH because AH is involved in development of the majority of the mechanisms underlying both hemorrhagic and ischemic stroke.

[The prevention of acute disorders of cerebral circulation: the theory and the reality]. / Profilaktika ostrykh narushenii mozgovogo krovoobrashcheniia: teoriia i real'nost'.

It would be valid to conduct prophylaxis of acute cerebrovascular disturbances (ACVD) in the context of state integral program of prophylaxis of the main noninfectious diseases. Its basic principles are: control of risk factors, integral approach and priority of populational strategy. The main medical directions of ACVD prophylaxis are: control of arterial hypertension and prevention of cardioembolic insult in patients with heart rhythm disorders. It is also possible to prevent repeated ACVD in patients with transitory ischemic attacks and minor insults. The best result is prognosed in combination of the state policy of providing the healthy mode of life of population and medical prophylaxis of ACVD in high risk groups.

[Blood pressure variability (based on 24-hour monitoring data) in mild arterial hypertension]. / Variabel'nost' arterial'nogo davleniia (po dannym 24-chasovogo monitorirovaniia) pri miagkoi arterial'noi gipertonii.

To evaluate the condition of target organs in patients with mild arterial hypertension (MAH) under normal and high arterial pressure variability (APV), the authors examined 84 MAH males aged 40-60 and 14 matched healthy controls. At 24-h monitoring it was revealed that 32% of MAH patients had high variability of daytime and night arterial pressure which occurred more frequently in atherosclerotic lesion of extracranial carotid artery portions. MAH patients with high APV against those with normal APV develop carotid artery atherosclerosis 3.5 times more frequently, vascular disorders of the fundus of the eye stage II with angiosclerosis and thickening of the interventricular septum 2.5 and 1.8 times more frequently, respectively.

[Lesions of the major arteries of the head (a population ultrasonic study)]. / Porazhenie magistral'nykh arterii golovy (populiatsionno-ul'trazvukovoe issledovanie).

The screening of the random sample from an open population of males aged 40-65 was performed to compare frequency and severity of hemodynamic changes in major head arteries (MHA) due to atherosclerosis in subjects with vascular diseases and clinically normal controls. 866 of the examinees were subjected to MHA ultrasonic dopplerography. Normal circulation appeared only in 13% of the examinees. The rest of them had insufficient circulation or at least one vessel affected with stenosis. The standard index of MHA stenosis amounted to 20.2%. The frequency of MHA stenosis was related to the age, vascular involvement and severity of the latter.

[The pathology of catecholamine metabolism in cerebrovascular diseases]. / K patologii metabolizma katekholaminov pri tserebrovaskuliarnykh zabolevaniikh.

Blood catecholamines were investigated with high-performance liquid chromatography and electrochemical detection in 95 patients with cerebrovascular affections. On day 1-3 since ischemic apoplexy blood norepinephrine and dopamine levels increased significantly. This is possibly due to their active release from neurons in brain tissue ischemia. High blood catecholamines are thought an unfavourable factor aggravating the disease and responsible for cardiac sequelae. Ways of cerebral tissue protection in case of ischemia are suggested.

[Atherosclerosis of the major arteries of the head and the content of lipoprotein(a) in the blood plasma]. / Ateroskleroz magistral'nykh arterii golovy i soderzhanie lipoproteida(a) v plazme krovi.

It is established that atherosclerotic patients with impaired major arteries of the head have high concentration of blood lipoprotein (a) following ischemic disorder of cerebral circulation. Irrespectively of the clinical picture, atherosclerosis of the major head arteries correlated in severity with blood levels of lipoprotein (a). It is suggested that lipoprotein (a) can serve an essential biochemical marker of major head arteries atherosclerosis.

[The epidemiology of autonomic disorders--the autonomic dystonia syndrome--and its characteristics in cerebrovascular pathology]. / Epidemiologiia vegetativnykh rasstroistv--sindroma vegetativnoi distonii--i osobennosti ee pri tserebrovaskuliarnoi patologii.

To study the prevalence of vegetative dystonia (VD) and the role it plays in the pathogenesis of cerebrovascular diseases (CVD), 8,500 population of different regions of this country and patients with the main forms of CVD underwent an epidemiological study with the aid of a specially devised questionnaire. It is shown that (1) VD is highly prevalent among the healthy population; (2) the intensity of VD depends on the region of living, sex, age, occupational factors; (3) VD in patients with CVD is characterized by high intensity, especially in initial manifestations of cerebral circulatory disorders, and by a particularly severe course in menopausal women.

[Study of prevalence and structure of cerebrovascular disorders in different regions of the USSR based on simultaneous epidemiological examinations]. / Rasprostranennost' i struktura tserebrovaskuliarnykh zabolevanii v razlichnykh regionakh SSSR po dannym adnomomentnogo épidemio- logicheskogo issledovaniia.

The authors describe the data of the screenings of the representative random samples from the open male population aged 20 to 54 years, carried out in accordance with the common program in 6 cities of this country. The prevalence of definite cases of cerebrovascular diseases (CVD) ranged from 7.7% in Moscow to 12% in Irkutsk. As to the structure of cerebrovascular injuries, the initial manifestations of brain blood supply insufficiency accounted for 68%. The prevalence of CVD turned out to be the greatest in Western Siberia, the least in the European region. The transcaucasian republics occupy an intermediate position.

[Effectiveness of a stroke prevention program in a high-risk group]. / Effektivnost' programmy preduprezhdeniia insul'ta v gruppe povyshennogo riska.

As a result of screening of males born in 1922-1931 (n = 2435) a group with a high risk for stroke development (n = 620) was identified. A total of 430 of these patients were followed up for 2 years. At the final stage the authors collected data on 80% of the patients who had undergone the primary examination and carried out a new screening of age-matched males. The morbidity rate related to cerebral stroke was 2.59% in the high risk group and 1.48% in the remaining population. The incidence of myocardial infarction in the above two groups was 5.01% and 1.80% respectively. At the same time 55.9% of new cases of cerebral stroke and 44.2% of myocardial infarction occurred in individuals who were not included into the high risk group and had an "intermediate" risk of the development of these diseases. It is concluded that the problem of combating cerebral stroke cannot be solved by putting emphasis exclusively on prevention in high risk groups and that it should be combined with wide-scale prophylactic work among the population.

[Speech disorders with localization of the vascular focus in deep structures of the dominant hemisphere of the brain]. / Narusheniia rechi pri lokalizatsii sosudistogo ochaga v glubokikh strukturakh dominantnogo polushariia golovnogo mozga.

The authors present the clinical picture and time-course of aphasia (A) in 25 patients, 18 of whom had had hemorrhagic and 7 ischemic stroke. Dynamic neuropsychological examination and computer-aided tomography (CT) of the brain were carried out. The development of marked and stable A was observed in 20% of the cases. The frequency was higher with brain infarction and lower with cerebral hemorrhage. In 3 cases of deep localization of brain infarction the authors describe a peculiar speech syndrome not observed in other aphasic patients. It was characterized by (1) intactness of mechanisms underlying the realization of speech despite the presence of marked aphasia, (2) greater variability and inconsistence of results of implementation by patients of speech tasks. Clinico-CT correlations gave grounds for explaining the rate and degree of speech recovery, as well as the nature of A with the predominant lesion to some or other deep structures of the left hemisphere of the brain.

[Clinical picture and dynamics of sensomotor aphasia in cerebrovascular pathology]. / Klinika i dinamika sensomotornoi afazii pri sosudistoi patologii golovnogo mozga.

Thirty-seven patients (27 with ischemic and 10 with hemorrhagic strokes) were examined. The patients were followed up for 1 to 5 years. Clinical and neuropsychologic examinations over time and computer-aided tomography of the brain were carried out. The syndrome of sensomotor aphasia was shown to be heterogeneous. Two variants of the syndrome were specified which differed by the clinical manifestations of aphasia, the time-course of recovery of various speech functions, and the localization of affection. The correlation between the recovery of individual speech functions and the cerebral blood supply is discussed.

[Speech syndrome and its course in patients who have sustained an ischemic stroke (clinico-tomographic study)]. / Osobennosti rechevogo sindroma i ego dinamiki u bol'nykh, perenesshikh ishemicheskii insul't (kliniko-tomograficheskoe issledovanie).

Clinical and tomographic examinations of 40 patients with aphasia developed after an ischemic stroke were carried out. In more than half of them no correlation between the aphasia gravity and character on the one hand, and the size and localization of the ischemic focus (or foci) in the brain on the other was noted. With similar character and gravity of the speech disorder the size and localization of the ischemic foci may be different, ad vice versa. It has been shown that the interrelations between the focal pathology of the brain and the character and gravity of speech disorders are very complicated. One should take into consideration the possibility of individual organization of the speech functions, the degree of the speech activity automatism before the disease, and the state of the cerebrovascular system as a whole.