[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.

[A state of hemorheological system in patients subjected to carotid endarterectomy with atherosclerotic lesion of the major cerebral arteries].

To study the influence of changes in the blood rheological indices and blood coagulation on development, progression and clinical course of restenosis and thrombosis, 62 patients (mean age 63.4 +/- 6.0 years), were followed up for 2-15 years after carotid endarterectomy. Above 50% (maximum 70%) restenosis was observed in 7% cases. No critical postoperative restinosis was observed. In 12% patients, restenosis was accompanied with carotid artery occlusion and hematocrit, with fibrinogen (FG) being significantly increased in the absence of fibrinolytic activity (FL) elevation, indicating hemorheological disorders and homeostasis activation in such patients. Long-term follow-up showed that viscosity blood characteristics were elevated but functional activity of platelets and FA in patients did not differ from those in healthy subjects. At the same time, FG was high and fibrinolysis index was lower than mean statistical value that indicated predominance of blood procoagulation activity.

[The follow up of patients with extracranial pathology of the carotid arteries and ischemic disorders of cerebral circulation]. / Katamnez bol'nykh s ékstranial'noi patologiei sonnykh arterii i ishmicheskimi narushaniiami mozgovogo krovoobrashcheniia.

According to the populational studies, about 50% of ischemic disorders of cerebral circulation, both persistent and transient, are induced by thrombotic or embolic complications of atherosclerotic plaques which produce an adverse effect on the large and small caliber arteries; about 20-25% is associated with lesion of the small diameter intracranial vessels, about 20% with embolism from the heart, and the remaining disorders fall within other rare causes. The prevalence of atherosclerotic lesions of the vessels feeding the brain, the severity of their clinical manifestations, insufficient efficacy of conservative therapy and the high risk of surgical treatment remain as before a matter of great medical and social concern. In connection with an appreciable progress of vascular surgery carotid endarterectoray (GEAE) as one of the radical approaches to correction of the pathology of the carotid artery segment is widespread at the large centers of vascular surgery of different countries. However, in spite of the fact that CEAE is an advanced and radical technique of preventive operation, it produces only a local effect on vascular diseases whereas the other, no less important pathogenetic mechanisms leading to disorders of cerebral circulation remain unchanged and demand drug correction to avoid repeated disorders of cerebral circulation. Analysis of the long-tern results evidences a stable and lasting effect of CEAE. The postoperative clinical manifestations can be used as the main criterion for the efficacy of CEAE, especially as compared to the purely conservative therepy. The results of the long-term follow up (over the period as long as 15 years) of a large group of operated patients demonstrate that the majority of them did not show the emergence of the new focal neurologic symptomatology in the ipsilateral hemisphere and only a small percentage of cases developed stroke. The major western statistics provide the analogous results.