Early stages of hypertensive encephalopathy development and modern potential of cerebro-protective therapy

Abstract

Aim. To study structural cerebral changes in patients with arterial hypertension (AH), taking into consideration 24-hour blood pressure monitoring (BPM) results and their dynamics during antihypertensive therapy.Material and methods. In total, 212 AH patients aged 40-60 years (mean age 48,3±5,7 years) were examined. Cerebral magnetic resonance tomography, cerebral emission computed tomography, and 246hour BPM were performed. The therapy included enalapril (5-20 mg/d; n=32) and indapamide retard (1,5 mg/d; n=32) for 24 weeks.Results. Structural cerebral changes, observed in 89,5% of AH patients, were significantly associated with 24-hour BPM parameters. Indapamide and enalapril therapy was associated with significant BP reduction, according to 24-hour BPM data, as well as with cerebral perfusion improvement (primarily in occipital region) and decreased disturbances of liquor circulation and periventricular edema. The parameters studied improved to a greater extent in the indapamide group.Conclusion. Circadian BP profile normalization, during indapamide retard therapy, was associated with improved cerebral perfusion and structure. Positive dynamics of cerebral parameters was manifested to a lesser extent in the enalapril group.

Keywords

• hypertensive encephalopathy
• magnetic resonance tomography
• cerebral perfusion
• therapy