INFLUENCE OF ARTERIAL HYPERTENSION WITH DIFFERENT DURATION ON NEUROLOGICAL AND FUNCTIONAL OUTCOME OF ISCHEMIC STROKE

Abstract

Relevance. The outcome of acute ischemic stroke depends on the complex interaction of many factors, such as those that are not controllable, and those that can be affected. An important prognostic value of blood pressure level during the first day after a stroke has been proven. At the same time, the relationship between the primary ischemic stroke outcome and various characteristics of arterial hypertension (duration, severity of pre-existing arterial hypertension, its course) continues to be studied. Objective: to study the relationship between the degree of neurological recovery and functional dependence in patients after ischemic stroke within 1 year, depending on the duration of arterial hypertension in the pre-stroke period. Materials and methods. The study included 156 patients, 6 patients were excluded because of the loss of communication with them and refusal to participate in the study. 150 patients, 74 (49,3 %) women and 76 (50,7 %) men aged 43 to 80 years (mean age 67.4±0,71 years) with a history of ischemic stroke and the presence of arterial hypertension were examined during the year, on 1, 21 days, after 6 and 12 months. The stroke severity was evaluated by NIHSS, functional dependence – by the Barthel Index. The diagnosis of arterial hypertension, its severity, duration was based on data from clinical, instrumental examination and medical documentation. Results. The severity of ischemic stroke by NIHSS at the time of admission was 9,5±0,35 points; the average degree of neurological disorders severity was determined in 57,4 % of patients. The arterial hypertension duration in the history of examined patients varied from 2 to 45 years, the average 12,3±0,64 years. The most commonly reported was the arterial hypertension with its duration 6-10 years (46 %). In the case of arterial hypertension duration up to 5 years, the ischemic stroke has developed in 18,7 % of patients. The duration of arterial hypertension in anamnesis significantly correlated with the severity of the neurological deficiency at the time of admission and at the end of the acute period (r=0,65; r=0,66, respectively). The degree of functional dependence in patients with arterial hypertension duration over 10 years was worse comparatively with patients that had arterial hypertension duration up to 5 years and even with patients with a duration from 6 to 10 years after 6 and 12 months period (61,7±2,1; 90,9±1.1; 82,8±1,4 and 64,9±2,7; 93,2±0,9; 85,7±1,3, correspondingly, all p <0,05). Conclusions. The reliable direct relationship between the arterial hypertension duration and the degree of neurological disorders in the acute period of ischemic stroke and the reverse relationship between the duration of arterial hypertension and the degree of functional recovery in all periods of the study were found. The most patients with moderate and severe functional dependence in a year have arterial hypertension duration more than 10 years.

Keywords

• ischemic stroke, arterial hypertension, blood pressure, neurological and functional recovery