I.B. BAZINA, O.A. KOZYREV, L.A. IPPOLITOVA, K.A. GULAKOVA, S.A. MOLOTKOVA, M.V. PAVLOVA

 Smolensk State Medical University, Smolensk

  Contact details:

Bazina I.B. — PhD (Medicine), Associate Professor of the Department of Hospital Therapy

Address: 28 Krupskaoy St., 214019 Smolensk, Russian Federation, tel.: +7-919-047-22-27, e-mail: billy_boss@mail.ru

Arterial hypertension (AH) is the main cause of ischemic and hemorrhagic strokes, which are considered, along with myocardial infarction, the leading cause of mortality from cardiovascular diseases. The unity of cardio-cerebral pathology has been proven, which is based on mechanisms and criteria that make it possible to compare and assess the prognosis of ischemic and hemorrhagic stroke.

The purpose — to compare biochemical and hemodynamic parameters of ischemic and hemorrhagic strokes and their possible impact on disease outcomes.

Material and methods. Medical records of patients treated in the Department for patients with acute cerebrovascular accident (ischemic and hemorrhagic stroke) were analyzed.

Results. 132 41–90 y. o. patients were examined, of them 92 people with ischemic stroke, 40 with hemorrhagic stroke. Among the risk factors for ischemic stroke were: diabetes mellitus — 15.2%, permanent atrial fibrillation — 21.7%, post-infarction cardiosclerosis — 8.7%, smoking — 3.3%, hypercholesterolemia — 68.3%, hypertension — 100% of patients. 3.3% of patients died. In hemorrhagic stroke: hypertension — 100% of patients, permanent atrial fibrillation — 17.5%, post-infarction cardiosclerosis — 7.5%, smoking — 8.7%, diabetes mellitus — 17.5%, recurrent stroke — 2.5%, hypercholesterolemia — 80% of patients. 50% of patients died (p ≤ 0.05). In hemorrhagic stroke, compared with ischemic one, dyslipidemia was more pronounced, fibrin, fibrinogen values were increased, systolic blood flow rate in the internal carotid artery was increased, glomerular filtration rate was reduced, which may indicate an unfavorable prognosis of the disease. This is supported by the high mortality in the hemorrhagic stroke group.

Conclusion. Hemorrhagic stroke is less common than ischemic one, but it is much more severe, accompanied by high mortality of patients in the acute period of the disease. The severity of the course of hemorrhagic stroke, compared with ischemic one, is due to more pronounced disorders of the lipidogram and coagulogram, a decrease in the rate of glomerular filtration, and an increase in the rigidity of the vascular wall.

Key words: arterial hypertension, stroke, dyslipidemia, vascular wall rigidity.

  REFERENCES

1. Geraskina L.A. Arterial hypertension and stroke: cardio-neurological aspects of secondary prevention. Nevrologiya, neyropsikhiatriya, psikhosomatika, 2014, no. 2, pp. 56–61 (in Russ.).
2. Mustafin M.S., Novikova L.B., Akopyan A.P., Shakirov R.R. Neurosurgical aspects of hemorrhagic stroke. Annaly klinicheskoy i eksperimental’noy nevrologii, 2018, vol. 1, no. 12, pp. 19–23 (in Russ.).
3. Visseren F.L.J., Mach F., Smulders Y.M., Carballo D. et al. ESC Scientific Document Group, 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies with the special contribution of the European Association of Preventive Cardiology (EAPC). Eur. Heart J, 2021, vol. 42 (34), pp. 3227–3337.
4. Ezhov M.V., Kukharchuk V.V., Sergienko I.V., Alieva A.S.B. et al. Lipid metabolism disorders. Clinical guidelines 2023. Rossiyskiy kardiologicheskiy zhurnal, 2023, vol. 5, no. 28, pp. 54–71 (in Russ.).
5. Clinical guidelines. Chronic kidney disease (CKD). Nefrologiya, 2021, vol. 5, no. 25, pp. 10–82 (in Russ.).
6. Drozdetskiy S.I., Kuchin K.V. Arterial stiffness in everyday clinical practice: what is important for a practicing physician to know. Mezhdunarodnyy zhurnal serdtsa i sosudistykh zabolevaniy, 2018, vol. 6, no. 19, pp. 37–43 (in Russ.).
7. Gusev E.I., Martynov M.Yu., Kamchatnov P.R. Ischemic stroke. Current state of the problem. Nevrologiya, 2013, vol. 83, no. 5, pp. 7–12 (in Russ.).
8. Popov S.V., Antonchenko I.V. The importance of cardiac electrophysiology in choosing treatment tactics for atrial fibrillation. Praktikuyushchiy vrach, 2001, vol. 20, no. 2, pp. 14–18 (in Russ.).
9. Stakhovskaya L.V., Kotova S.V. Insul’t. Rukovodstvo dlya vrachey [Stroke. A Manual for Physicians]. Moscow: MIA, 2014. Pp. 234–260.
10. Garsia-Donaire Zh.A., Ruilope L.M. Cardiovascular-renal connections in the cardiorenal continuum. Nefrologiya, 2013, vol. 17, no. 1, pp. 11–19 (in Russ.).
11. Mitchell G.F. Effects of central arterial aging on the structure and function of the peripheral vasculature: implications for end-organ damage. J. Appl. Physiol, 2008, no. 105, pp. 1652–1660.