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Treatment of hypertension as a prevention (PREVENTIVE) measure of primary and recurrent strokes
Currently, the development of effective treatment methods for cardiovascular diseases is a relevant direction in medical research, which also has a high social significance. This is explained by the fact that various disorders of the cardiovascular system are the main cause of premature death or disability. The analysis of the general statistics of the causes of death in the Russian Federation shows that the first cause of death is coronary heart disease (25.8%), the second one is mortality from cerebrovascular diseases (21.5%), and the third cause is cancer.
Prevention of primary stroke
The prevention of cerebral stroke is based on the elimination of risk factors that predispose to some extent, its development. Epidemiological studies found the main risk factors for acute cerebrovascular accidents, which significantly increase the chance of developing such diseases.
Hypertension is the most common, but one of the most modifiable risk factors for the development of stroke in the population. The danger of this pathology is primarily associated with its wide prevalence - more than 30% of adults in the Russian Federation have high blood pressure of 140/90 mmHg. It is difficult to more accurately assess the impact of hypertension on stroke risk due to the inevitability of other risk factors (for example, such as atrial fibrillation or age). In addition, the effect of this factor varies with the level of blood pressure. For example, a recent analysis showed that the chance of developing a stroke in patients with high diastolic blood pressure is approximately 10 times higher than in patients with low values of this indicator.
Antihypertensive therapy
Antihypertensive therapy can significantly reduce the risk of stroke. The analysis of 14 clinical studies indicated a decrease in the average risk of developing a primary stroke by 39% due to therapy with beta blockers and diuretics. At the same time, the therapy reduced the systolic blood pressure by 10-21 mmHg and diastolic blood pressure by 5-6 mmHg.
For the most part, the reduction in the incidence of cerebral stroke was due to a reduction in the risk of signalling a hemorrhagic type. In recent years, evidence had also been obtained in support of the theory that calcium antagonists and angiotensin converting enzyme inhibitors have a beneficial effect on the course of the disease in patients with high blood pressure and other factors that increase the risk of developing atherosclerosis.
The studies from recent years have filled the gap, which was present in the knowledge of the influence of antihypertensive drugs on the long-term outcomes of hypertension. This significantly expands the opportunities currently offered for the treatment of patients with this pathology, in terms of choosing the first drug to reduce blood pressure and preventing the occurrence of possible complications, including a stroke.
Prevention of hypertension in stroke survivors
Whether or not therapy influences a stroke patient’s blood pressure remains yet to be discovered. The recurrent cerebral circulation problems during the first month occur in 3-6% of patients, while during the first year - in 10%. The total risk of such a disorder developing during the following five years is about 25%.
The risk factors for a recurrent stroke remain almost the same as for the primary development of disorders. Blood pressure remains one of the most important factors. Despite the fact that hypertension increases risk of recurrent stroke, the specific estimated figures have not been found to date. In addition, the question of the intensity of antihypertensive therapy has not yet been studied: an excessive pressure reduction can have a negative effect on the brain.
A relationship between the risk of recurrent stroke and hypertension, as well as the effect of antihypertensive therapy on the prognosis of relapse can be considered confirmed. Some results on the clinical use of drugs among stroke patients were also obtained.
The results of one of such studies showed that perindopril-based therapy can prevent one stroke in 14 patients (within five years).
It was for the first time that a large-scale controlled study proved the beneficial effect of pressure lowering therapy on the course of the cerebrovascular pathology. The favorable results of the course noted a significant reduction in the risk of recurrent stroke and other cardiovascular complications, a general improvement of the prognosis.
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