Early stages of hypertensive encephalopathy development and modern potential of cerebroprotective therapy
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 24-hour 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.