Differentiated approach to treatment of arterial hypertension in patients, suffering ischemic cerebral stroke
Objective. To raise the efficacy of treatment of arterial hypertension in patients, suffering ischemic cerebral stroke of the middle grade of severity on background of determination of hemodynamic variant of arterial hypertension.
Materials and methods. Prospective nonrandomized investigation concerning 42 patients, suffering ischemic cerebral stroke of middle severity in accordance to the insult severity scale of National Institute of Health (National Institutes of Health Stroke Scale - NIHSS), was conducted. The patients’ middle age have constituted (69.4 ± 1.4) yrs. There were the central hemodynamic indices measured, the arterial hypertension hemodynamic variant determined, the oxygen and hemodynamic status estimated, and in accordance to the results obtained - the differentiated antihypertensive therapy was administered. All the patients were divided into three groups, depending on hemodynamical variant of arterial hypertension: the first group – patients with eukinetic variant, the second group – patients with hypokinetic variant, the third group – patients with hyperkinetic variant. Hemodynamical variant of arterial hypertension was determined in accordance to the referent level of cardiac index. The groups were representative in accordance to age, height, the body mass, the main and concurrent pathology and the cerebral affection degree.
Results. In the patients, suffering initial eukinetic hemodynamical variant of arterial hypertension, the cardiac index have fluctuated from 2.88 to 4.67 l × min-1 × m-2, general peripheral vascular resistance have rested in the norm borders, the oxygen saturation level of arterial blood did not demand the oxygen therapy, index of the oxygen delivery have exceeded the appropriate values and fluctuated in borders from 541 to 903 l × min-1 × m-2. In complex of differentiated antihypertensive therapy there was applied a constant intravenous injection of magnesium sulfate in a daily dose 2500 - 5000 mg. For patients with initial hypokinetic hemodynamic variant of arterial hypertension following signs are characteristic: low cardiac index - from 1.65 to 2.08 l × min-1 × m-2, the enhanced general peripheral vascular resistance - 2813 (from 2393 to 3403) dyne × s-1 × cm-5 and the lowered index of the oxygen delivery - from 306 to 412 l × min-1 × m-2. Differentiated antihypertensive therapy was conducted, using urapidyl: intravenous boluses 1.25 – 2.5 mg with further infusion 5 - 40 mg × h-1. For hyperkinetic hemodynamic variant of arterial hypertension the raised cardiac index is characteristic – 3.75 l × min-1 × m-2 (fluctuated in borders from 3.62 to 4.10 l × min-1 × m-2), as well as normal general peripheral vascular resistance - 1189 (from 1055 to 1449) dyne × s-1 × cm-5 and raised index of the oxygen delivery - 762 (from 725 to 828) l × min-1 × m-2. Differentiated antihypertensive therapy was conducted, using labetalol: intravenous infusion with velocity 2 - 8 mg × min-1.
Conclusion. In the patients with ischemic cerebral stroke of the middle grade of severity the conduction of differentiated antihypertensive therapy, taking into account hemodynamic type of arterial hypertension and the oxygen-hemodynamic stabilization of the blood circulation system, improved the results of treatment and accelerated the rehabilitation duration.
Hong KS. Blood Pressure Management for Stroke Prevention and in Acute Stroke. J Stroke. 2017;19(2):152-165. doi: 10.5853/jos.2017.00164.
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018;49(3):46-110. doi:10.1161/STR.0000000000000158.
Bowry R, Navalkele DD, Gonzales NR. Blood pressure management in stroke: Five new things. Neurol Clin Pract. 2014;4(5):419-26. doi: 10.1212/CPJ.0000000000000085.
Zinchenko OK. Adaptative reserve in patients with autonomic disturbances in structure of posttraumatic and chronic inflammatory lesions of the central nervous system on the background of blood pressure systemic reduction (Analytical literature review. Part III). International neurological journal. 2015;(4):112-117. [Russian].
Widimsky P, Doehner W, DienerHC, Van Gelder IC, Halliday A, Mazighi M, et al. The role of cardiologists in stroke prevention and treatment: position paper of the European Society of Cardiology Council on Stroke. Eur Heart J. 2018;39(17):1567-73. doi: 10.1093/eurheartj/ehx478.
Chazova IE, Zhernakova YuV on behalf of the experts. Clinical guidelines. Diagnosis and treatment of arterial hypertension. Systemic Hypertension. 2019;16(1):6-31. doi: 10.26442/2075082X.2019.1.190179. [Russian].
Khasanova DR, Danilov VI. Insult. Sovremennye podkhody diagnostiki, lecheniya i profilaktiki. Moskva: GEOTAR-MEDIA; 2019. 352 s. [Russian].
Usenko LV, Maltseva LA, Tsarev AV. Ischemic Attack as Seen by a Neuroresuscitator: Current Approaches to Intensive Care. General Reanimatology. 2005;1(1):60-70. doi: 10.15360/1813-9779-2005-1-60-70. [Russian].
Ataman AV. Patologicheskaya fiziologiya v voprosakh i otvetakh. Uchebnoe posobie. Kyiv: Vishcha shkola; 2000. 608. [Russian].
Zanchetti A, Grassi G, Mancia G. When should antihypertensive drug treatment be initiated and to what levels should systolic blood pressure be lowered? A critical reappraisal. J Hypertens. 2009;27(5):923-34.
Qureshi AI, Palesch YY, Barsan WG, Hanley DF, Hsu CY, Martin RL, et al. Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage. N Engl J Med. 2016;375(11):1033-43. doi: 10.1056/NEJMoa1603460.
Garga A, Dubrov S, Gavrilenko O. Treatment of acute brain disease in the intensive therapy department (review of clinical recommendations and instructions). Pain, anaesthesia and intensive care. 2019;1(86):37-52.
doi: 10.25284/2519-2078.1(86).2019.159556. [Ukrainian].
Trivedi M, Coles JP. Blood pressure management in acute head injury. J Intensive Care Med. 2009;24(2):96-107. doi: 10.1177/0885066608329602.
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