On the importance of arterial hypertension in the development of cerebral stroke

Cerebrovascular disease (CVD) is an important medical and social problem worldwide, which is one of the leading causes of mortality and disability. The prevalence of arterial hypertension (AH) in the population is too high. In the developed world, up to 20% of the adult population suffers from hypertension, and among people over the age of 65, it is about 50%. It should be noted that the population as a whole is dominated by the so-called «mild» form of AH (AH of the 1st degree), which is detected in about 60% of patients. An increase in blood pressure (BP) above 140/90 mmHg is recorded in about 80% of patients on the 1st day of ischemic stroke. Systolic BP is 160 mmHg and higher in 60% of patients with ischemic stroke. Higher BP values are detected in the 1st hours of stroke compared to the values of daily BP monitoring. In the observation of patients who had their BP measured immediately before the development of ischemic stroke, it was significantly higher. AH is associated with an increase in BP in all subtypes of ischemic stroke. It should be noted that an increase in BP in ischemic stroke can cause hemorrhagic transformation of infarction, increased cerebral edema and increased intracranial pressure. However, maintaining a slightly elevated BP in ischemic stroke is necessary to maintain perfusion pressure in the ischemic brain area, and lowering BP can exacerbate ischemia. The aim of our study was to elucidate the pathogenetic mechanisms of cerebral stroke development, the main factor of which was AH and its correction in the acute period. During many years of work in the neurovascular center of the Kyiv Clinical Emergency Hospital, thousands of patients were under our supervision. We analyzed the histories of 402 patients with ischemic stroke who had a history of AH. The patients were aged 46 to 76 years, and had been suffering from AH for 5 to 15 years. The patients were examined clinically by a neurologist, cardiologist, intensivist, using modern stroke severity scales (National Institutes of Health Stroke Scale (NIHSS), etc.) and the Glasgow Coma Scale to determine the consciousness and severity of the patient’s condition, instrumental and visualization methods (doppler ultrasound, electrocardiography, echocardiography, computed tomography, magnetic resonance imaging in angiography mode, angiography if necessary). Laboratory methods were used purposefully for patients with cardiocerebral and cerebrovascular pathology. A comparative analysis was performed in the acute period of cerebral stroke and in the early period after stroke.