nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2012-370nnp-340Research ArticleArticlesСтатьиAntyhypertensive therapy-based secondary prevention of ischemic strokeВторичная профилактика ишемического инсульта на основе антигипертензивной терапииParfenovVladimir AnatolyevichParfenovVladimir Anatolyevich

Department of Nervous Diseases, Faculty of Therapeutics

Department of Nervous Diseases, Faculty of Therapeutics

vladimirparfenov@mail.ruVerbitskayaS VVerbitskayaS V

Department of Nervous Diseases, Faculty of Therapeutics

Department of Nervous Diseases, Faculty of Therapeutics

-StarchinaYu AStarchinaYu A

Department of Nervous Diseases, Faculty of Therapeutics

Department of Nervous Diseases, Faculty of Therapeutics

-20121503201241NO1 (2012)96101Copyright © Parfenov V.A., Verbitskaya S.V., Starchina Y.A., 20122012Parfenov V.A., Verbitskaya S.V., Starchina Y.A.Parfenov V.A., Verbitskaya S.V., Starchina Y.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/340

The paper reviews the data available in the literature on the prevention of ischemic stroke by using antihypertensive therapy. It gives international guidelines and the results of randomized placebo-controlled trials of the use of different antihypertensive drugs in patients with prior stroke or transient ischemic attack. The possible neuroprotective effects of angiotensin II receptor blockers are discussed when analyzing the advantages of eprosartan over nitrendipine in the secondary prevention of stroke. The realities and optimization of secondary prevention of stroke in outpatient practice are analyzed.

Представлен обзор данных литературы о вторичной профилактике ишемического инсульта на основе использования антигипертензивной терапии. Приведены международные рекомендации и результаты крупных рандомизированных плацебоконтролируемых исследований, посвященных использованию различных антигипертензивных средств у больных, перенесших инсульт или транзиторную ишемическую атаку. При анализе преимуществ эпросартана перед нитрендипином во вторичной профилактике инсульта обсуждаются возможные нейропротективные эффекты блокаторов рецепторов ангиотензина II. Анализируются реалии и оптимизация вторичной профилактики инсульта в амбулаторной практике.

вторичная профилактика ишемического инсультаантигипертензивные препаратыэпросартанsecondary prevention of ischemic strokeantihypertensive drugseprosartanReferences<div><p>Шевченко О.П., Праскурничий Е.А., Яхно Н.Н. и др. Артериальная гипертония и церебральный инсульт. М., 2001;192 с.</p><p>Суслина З.А., Гераскина Л.А., Фонякин А.В. Артериальная гипертония, сосудистая патология мозга и антигипертензивное лечение. М.: Медиаграфикс, 2006;200 с.</p><p>Sacco R.L., Adams R., Albers G. et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Stroke 2006;37:577—617.</p><p>European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack. Cerebrovasc Dis 2008;25:457—507.</p><p>Суслина З.А., Фонякин А.В., Гераскина Л.А. и др. Практическая кардионеврология. М.: ИМА-ПРЕСС, 2010;304 с.</p><p>Furie K.L., Kasner S.E., Adams R.J. et al. Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2011;42:227—76.</p><p>Prospective Studies Collaboration. Cholesterol, diastolic blood pressure, and stroke: 13 000 strokes in 450 000 people in 45 prospective cohorts. Lancet 1995;346:1647—53.</p><p>Lewington S., Clarke R., Qizilbash N. et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360:1903—13.</p><p>Vasan R.S., Beiser A, Seshardi S. et al. Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Stud. JAMA 2002;287:1003—10.</p><p>Chalmers J., MacMahon S., Anderson C. et al. Clinician's manual on blood pressure and stroke prevention. Second ed. London, 2000;129 p.</p><p>Rashid P., Leonardi-Bee J., Bath P.P. Blood Pressure Reduction and Secondary Prevention of Stroke and Other Vascular Events. Stroke 2003;34:2741—8.</p><p>Zhang H., Thijs L., Staessen J.A. Blood Pressure Lowering for Primary and Secondary Prevention of Stroke. Hypertension 2006;48:187—95.</p><p>Lawes C.M.M., Bennett D.A., Feigin V.L. et al. Blood pressure and stroke: an overview of published reviews. Stroke 2004;35:776—85.</p><p>Lakhan S.E., Sapko M.T. Blood pressure lowering treatment for preventing stroke recurrence: a systematic review and meta-analysis. Int Arch Med 2009;2:30.</p><p>Rothwell P.M., Howard S.C., Spence J.D. et al. Relationship between Blood Pressure and Stroke Risk in Patients With Symptomatic Carotid Occlusive Disease. Stroke 2003;34:2583—92.</p><p>The Dutch TIA Trial Study Group. Trial of secondary prevention with atenolol after transient ischemic attack or nondisabling ischemic stroke. Stroke 1993;24:543—8.</p><p>Post-stroke antihypertensive treatment study. A preliminary result. PATS Collaborating Group. Chin Med J 1995;108:710—7.</p><p>Yusuf S., Sleight P., Pogue J. et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients: the Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000;342:145—53.</p><p>Svensson P., de Faire U., Sleight P. et al. Comparative effects of ramipril on ambulatory and office blood pressures: a HOPE Substudy. Hypertension 2001;38:e28-e32.</p><p>PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient schaemic attack. Lancet 2001;358:1033—41.</p><p>Schrader J., Luders S., Kulschewski A. et al. Mortality and morbidity after stroke, Eprosartan compared with Nitrendipine for secondary prevention. Principal results of a prospective randomised controlled study (MOSES). Stroke 2005;36:1218—26.</p><p>Telmisartan to Prevent Recurrent Stroke and Cardiovascular Events. N Engl J Med 2008;359:1225-37.</p><p>De la Sierra A. Effects of eprosartan on target organ protection. Vasc Health Risk Manag 2006;2:79-85.</p><p>Schrader J., Kulschewski A., Dendorfer A. Inhibition of the renin-angiotensin system and the prevention of stroke. Am J Cardiovasc Drugs 2007;7:25-37.</p><p>Парфенов В.А., Старчина Ю.А., Яхно Н.Н. Эпросартан (теветен) в профилактике повторного инсульта и когнитивных нарушений. Неврол журн 2007;1:46—51.</p><p>Schwander B., Gradl B., Zöllner Y. et al. Cost-utility analysis of eprosartan compared to enalapril in primary prevention and nitrendipine in secondary prevention in Europe — the HEALTH model. Value Health 2009;12:857-71.</p><p>Парфенов В.А., Рыжак А.А. Неврологические аспекты оптимизации антигипертензивной терапии. Неврол журн 2003;2:26—9.</p><p>Вербицкая С.В., Парфенов В.А. Вторичная профилактика инсульта в амбулаторных условиях. Неврол журн 2011;1:17—21.</p></div><br /><div><p>Шевченко О.П., Праскурничий Е.А., Яхно Н.Н. и др. Артериальная гипертония и церебральный инсульт. М., 2001;192 с.</p><p>Суслина З.А., Гераскина Л.А., Фонякин А.В. Артериальная гипертония, сосудистая патология мозга и антигипертензивное лечение. М.: Медиаграфикс, 2006;200 с.</p><p>Sacco R.L., Adams R., Albers G. et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Stroke 2006;37:577—617.</p><p>European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack. Cerebrovasc Dis 2008;25:457—507.</p><p>Суслина З.А., Фонякин А.В., Гераскина Л.А. и др. Практическая кардионеврология. М.: ИМА-ПРЕСС, 2010;304 с.</p><p>Furie K.L., Kasner S.E., Adams R.J. et al. Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2011;42:227—76.</p><p>Prospective Studies Collaboration. Cholesterol, diastolic blood pressure, and stroke: 13 000 strokes in 450 000 people in 45 prospective cohorts. Lancet 1995;346:1647—53.</p><p>Lewington S., Clarke R., Qizilbash N. et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360:1903—13.</p><p>Vasan R.S., Beiser A, Seshardi S. et al. Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Stud. JAMA 2002;287:1003—10.</p><p>Chalmers J., MacMahon S., Anderson C. et al. Clinician's manual on blood pressure and stroke prevention. Second ed. London, 2000;129 p.</p><p>Rashid P., Leonardi-Bee J., Bath P.P. Blood Pressure Reduction and Secondary Prevention of Stroke and Other Vascular Events. Stroke 2003;34:2741—8.</p><p>Zhang H., Thijs L., Staessen J.A. Blood Pressure Lowering for Primary and Secondary Prevention of Stroke. Hypertension 2006;48:187—95.</p><p>Lawes C.M.M., Bennett D.A., Feigin V.L. et al. Blood pressure and stroke: an overview of published reviews. Stroke 2004;35:776—85.</p><p>Lakhan S.E., Sapko M.T. Blood pressure lowering treatment for preventing stroke recurrence: a systematic review and meta-analysis. Int Arch Med 2009;2:30.</p><p>Rothwell P.M., Howard S.C., Spence J.D. et al. Relationship between Blood Pressure and Stroke Risk in Patients With Symptomatic Carotid Occlusive Disease. Stroke 2003;34:2583—92.</p><p>The Dutch TIA Trial Study Group. Trial of secondary prevention with atenolol after transient ischemic attack or nondisabling ischemic stroke. Stroke 1993;24:543—8.</p><p>Post-stroke antihypertensive treatment study. A preliminary result. PATS Collaborating Group. Chin Med J 1995;108:710—7.</p><p>Yusuf S., Sleight P., Pogue J. et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients: the Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000;342:145—53.</p><p>Svensson P., de Faire U., Sleight P. et al. Comparative effects of ramipril on ambulatory and office blood pressures: a HOPE Substudy. Hypertension 2001;38:e28-e32.</p><p>PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient schaemic attack. Lancet 2001;358:1033—41.</p><p>Schrader J., Luders S., Kulschewski A. et al. Mortality and morbidity after stroke, Eprosartan compared with Nitrendipine for secondary prevention. Principal results of a prospective randomised controlled study (MOSES). Stroke 2005;36:1218—26.</p><p>Telmisartan to Prevent Recurrent Stroke and Cardiovascular Events. N Engl J Med 2008;359:1225-37.</p><p>De la Sierra A. Effects of eprosartan on target organ protection. Vasc Health Risk Manag 2006;2:79-85.</p><p>Schrader J., Kulschewski A., Dendorfer A. Inhibition of the renin-angiotensin system and the prevention of stroke. Am J Cardiovasc Drugs 2007;7:25-37.</p><p>Парфенов В.А., Старчина Ю.А., Яхно Н.Н. Эпросартан (теветен) в профилактике повторного инсульта и когнитивных нарушений. Неврол журн 2007;1:46—51.</p><p>Schwander B., Gradl B., Zöllner Y. et al. Cost-utility analysis of eprosartan compared to enalapril in primary prevention and nitrendipine in secondary prevention in Europe — the HEALTH model. Value Health 2009;12:857-71.</p><p>Парфенов В.А., Рыжак А.А. Неврологические аспекты оптимизации антигипертензивной терапии. Неврол журн 2003;2:26—9.</p><p>Вербицкая С.В., Парфенов В.А. Вторичная профилактика инсульта в амбулаторных условиях. Неврол журн 2011;1:17—21.</p></div><br />

The authors declare that there are no conflicts of interest present.