PROGNOSTIC VALUE OF AMBULATORY BLOOD PRESSURE MONITORING IN PATIENTS WITH EARLY-STAGE CEREBROVASCULAR DISEASE

Abstract

Introduction. Hypertension is one of the major risk factors for cerebrovascular disease (CVD). The defeat of the cerebral vessels occurs within a certain time. The duration of this process depends on a number of blood pressure (BP) characteristics, which can't be determined by conventional measurement of BP. For example, the important predictor of organ damage are blood pressure variability, the degree of night BP reduction, the blood pressure load. These rates are only available as a result of ambulatory blood pressure monitoring (ABPM). The aim of our study was to investigate the characteristics of BP during 24-h and their prognostic value in patients with different stages of cerebrovascular disease in young and middle-aged. Material and methods. We examined 117 people with the initial manifestations of chronic cerebrovascular insufficiency, dyscirculatory encephalopathy stage I and II. All patients underwent general-clinical, clinical neurology, clinical laboratory, neuroimaging examinations and ABPM. Results and discussion. Statistical significance was the correlation (Spearman) between the thickness of intima-media in the left common carotid artery and variability (SD) systolic blood pressure (r = 0,394, p = 0,006) and the average pulse blood pressure (r = 0,398, p = 0,001) during the day. Most patients (58.9% (53/90)) had the increased rate of systolic blood pressure in the morning was increased, and the value of a morning rise in systolic blood pressure greater than 55 mmHg. in 18.1% (19/105) patients. Was showed a trend to differences between patients with initial manifestations of chronic cerebrovascular insufficiency and dyscirculatory encephalopathy stage I by systolic blood pressure during the day (IT systolic blood pressure in patients with chronic cerebrovascular insufficiency (50,0 (46,3-56,0)) was lower than in patients with dyscirculatory encephalopathy stage I (56,5 (49,3­ 65,0 ))) and patients with initial manifestations of chronic cerebrovascular insufficiency (11.0 (8,0-15,4)) and dyscirculatory encephalopathy stage II (9,5 (7,5-11,0)) by heart rate variability. Conclusions. It should actively monitoring the average pulse pressure in patients with risk factors of cerebrovascular pathology because this indicator was different in persons with different stages of cerebrovascular disease. It was found that an important indicator for the formation of clinically significant stages of chronic cerebral ischemia is an indicator of systolic blood pressure load during the night, index, available only during the daily monitoring of blood pressure. Excessive reduction of blood pressure at night may have prognostic significance for formation of clinically significant stage of cerebrovascular diseases. In patients with early signs of cerebrovascular disease should actively pay attention to the rate of increase in systolic blood pressure in the morning.

Keywords

• ambulatory blood pressure monitoring, cerebrovascular pathology, the initial stages of the disease.