CHRONIC CEREBRAL ISCHEMIA AND ARTERIAL HYPERTENSION IN THE PRACTICE OF A THERAPIST AND General practitioner
Keywords:
chronic cerebral ischemia, arterial hypertension, cognitive impairment, antioxidant protection, Mexidol, Mexidol FORTE 250.Abstract
Introduction. Arterial hypertension (AH) is an increase in office SAD≥140 mmHg, and/or DAD ≥90 mmHg. Chronic cerebral ischemia (CIM) is a slowly progressive dysfunction of the brain that has arisen as a result of diffuse and/or small–focal damage to brain tissue in conditions of long-term insufficiency of cerebral blood supply. AH is one of the main etiological factors of CIM.
Objective. To study modern literature data on the etiology, features of pathogenesis, diagnosis, clinical manifestations, pathogenetically oriented therapy and mechanisms of action of the medicines Mexidol and Mexidol FORTE 250 on various links in the pathogenesis of patients with CHEM with hypertension.
Methods. The search was carried out in the electronic bibliographic databases PubMed, MEDLINE, Google Scholar, in an electronic resource on Russian-language, English-language sites, on the official Internet pages of open-access medical journals with articles on the problem of hypertension and CHEM and Mexidol. The articles published in the period from 2016 to 2023 are analyzed. Inclusion criteria: randomized controlled trials, meta-analyses, and original studies. Exclusion criteria: low-confidence studies, retrospective studies, scientific reviews, clinical cases.
Results and discussion. The etiology of the development of CHEM is hypertension, atherosclerosis, heart disease with risk of embolism, coronary heart disease (CHD), heart failure (HF), diabetes mellitus often a combination of these factors. In the pathogenesis of CHEM, a special role belongs to the ischemic cascade, disorders of cerebral microhemocirculation and increased lipoperoxidation processes. Clinical manifestations of CHEM with hypertension depend on the severity of the pathological process and vascular cognitive impairment of varying severity. Neuropsychological testing techniques are used to diagnose the initial stages of cognitive impairment. The mechanisms of action, multifactoriality, efficacy and safety of the medicine Mexidol in CHEM and hypertension are disclosed.
Conclusions. In the complex treatment of CHEM with hypertension, in addition to the appointment of hypotensive and lipid-lowering therapy, cerebrovascular, antiplatelet, neurometabolic medicines, the use of medicines with anti-ischemic, antioxidant, antihypoxant and membrane protective effects, which is the multimodal medicine Mexidol, is of particular importance.
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