avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2023-13-1-46-56avk-1561Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLEДИНАМИКА ВОССТАНОВЛЕНИЯ ПАЦИЕНТОВ С ИШЕМИЧЕСКИМ ИНСУЛЬТОМ В ЗАВИСИМОСТИ ОТ ПОКАЗАТЕЛЕЙ АРТЕРИАЛЬНОГО ДАВЛЕНИЯ И ЕГО ВАРИАБЕЛЬНОСТИRecovery Dynamics in Patients with Ischemic Stroke Depending on the Blood Pressure Indicators and Its Variabilityhttps://orcid.org/0000-0002-6395-1626ЕфремоваО. А.EfremovaO. A.

Ольга Алексеевна Ефремова

Белгород

Olga A. Efremova

Belgorod

efremova.bgu@gmail.comhttps://orcid.org/0000-0003-4515-7178БондаренкоЕ. В.BondarenkoE. V.

Белгород

Belgorod

https://orcid.org/0000-0002-6129-0625КамышниковаЛ. А.KamyshnikovaL. A.

Белгород

Belgorod

https://orcid.org/0000-0002-5308-8072ГоливецТ. П.GolivetsT. P.

Белгород

Belgorod

https://orcid.org/0000-0001-8541-0364ХамнагадаевИ. И.KhamnagadaevI. I.

Белгород

Belgorod

Белгородский государственный национальный исследовательский университетРоссияBelgorod State National Research UniversityRussian Federation2023250120231314656Copyright © Ефремова О.А., Бондаренко Е.В., Камышникова Л.А., Голивец Т.П., Хамнагадаев И.И., 20232023Ефремова О.А., Бондаренко Е.В., Камышникова Л.А., Голивец Т.П., Хамнагадаев И.И.Efremova O.A., Bondarenko E.V., Kamyshnikova L.A., Golivets T.P., Khamnagadaev I.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/1561

 

Цель — изучение неврологического и функционального восстановления у пациентов после ишемического инсульта в зависимости от показателей артериального давления (АД) и его вариабельности.

Материалы и методы

Материалы и методы: обследовано 150 пациентов с ишемич еским инсультом и артериальной гипертонией (АГ), которые находились на стационарном лечении в неврологическом отделении (76 (50,7 %) мужчин и 74 (49,3 %) женщин, средний возраст 67,4±7,3 лет). Всем пациентам проводили общепринятые физикальные и лабораторные исследования, измерение АД в динамике; для оценки тяжести неврологического дефицита на момент поступления в стационар, в динамике острого периода (до 21 суток) и на 21 сутки использовалась Шкала тяжести инсульта Национальных институтов здоровья США — NIHSS (National Institutes of Health Stroke Scale).

Результаты

Результаты. Установлено, что последствия острого периода инсульта зависят от уровня АД и его вариабельности в начале острого периода. Более чем 50–процентная вероятность снижения балла по NIHSS наполовину (от исходного) прогнозируется при наличии у пациента показателя стандартного отклонения (SD) систолического артериального давления (САД) на 1–3 сутки менее 12,4 мм рт. ст. Кроме этого, SD САД на 1–3 сутки и 1–6 сутки, и SD диастолического артериального давления (ДАД) с 1 по 3 сутки являются наиболее значимыми при оценке связи со степенью функциональных нарушений в конце острого периода инсульта.

Заключение

Заключение. Уровень АД и его вариабельность в течение острого периода ишемического инсульта позволяют прогнозировать тяжесть неврологического дефицита и функциональные последствия инсульта в восстановительном периоде (до 21 суток).

The study aims to neurological and functional recovery in patients after ischemic stroke depending on blood pressure (BP) parameters and its variability.

Materials and methods

Materials and methods: We examined 150 patients with ischemic stroke and arterial hypertension (AH) who were hospitalized in the neurological department (76 (50,7 %) men and 74 (49,3 %) women, mean age 67,4±7,3 years). All patients underwent standard physical and laboratory examinations, measurement of blood pressure in dynamics; The National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of neurological deficits at the time of admission to the hospital, in the dynamics of the acute period (up to 21 days) and on the 21st day.

Results

Results: It was found that the consequences of the acute period of stroke depend on the level of blood pressure and its variability at the beginning of the ac ute period. A more  than 50 percent probability of a decrease in the NIHSS score by half (from baseline) is predicted if the patient has a standard deviation (SD) systolic blood pressure (SBP) less than 12,4 mm Hg on days 1–3. In addition, SD SBP on days 1–3 and 1–6 days, and SD diastolic blood pressure (DBP) from 1 to 3 days are the most significant in assessing the relationship with the degree of functional impairment at the end of the acute period of stroke.

Conclusion

Conclusion: The level of blood pressure and its variability during the acute period of ischemic stroke makes it possible to predict the severity of the neurological deficit and the functional consequences of stroke in the recovery period (up to 21 days). 

ишемический инсультартериальная гипертонияфункциональный дефектфункциональное восстановлениевариабельность артериального давленияischemic strokearterial hypertensionfunctional defectfunctional recoveryblood pressure variabilityReferencesLorenz L.S., Doonan M. Value and Cost Savings from Access to Multi–disciplinary Rehabilitation Services After Severe Acquired Brain Injury. Front Public Health. 2021; 9(1): 753447. https://doi:10.3389/fpubh.2021.753447Lorenz L.S., Doonan M. Value and Cost Savings from Access to Multi–disciplinary Rehabilitation Services After Severe Acquired Brain Injury. Front Public Health. 2021; 9(1): 753447. https://doi:10.3389/fpubh.2021.753447Ingwersen T., Wolf S., Birke G. et al. Long–term recovery of upper limb motor function and self–reported health: results from a multicenter observational study 1 year after discharge from rehabilitation. Neurol Res Pract. 2021; (1): 66. https://doi:10.1186/s42466–021–00164–7Ingwersen T., Wolf S., Birke G. et al. Long–term recovery of upper limb motor function and self–reported health: results from a multicenter observational study 1 year after discharge from rehabilitation. Neurol Res Pract. 2021; (1): 66. https://doi:10.1186/s42466–021–00164–7Погурельская Е.П., Дудченко О.В., Ефремова О.А. и др. Приверженность лекарственной терапии больных сердечно-сосудистыми заболеваниями, перенесших мозговой инсульт. Научные ведомости Белгородского государственного университета. Серия: Медицина. Фармация. 2019; 42(1): 65-72. https://doi:10.18413/2075-4728-2019-42-1-65-72.Pogurelska Е.P., Dudchenko O.V., Efremova O.A. et al. Study of the adherence of medicinal therapy patients with cardiovascular diseases and cerebral brain stroke. Nauchny`e vedomosti Belgorodskogo gosudarstvennogo universiteta. Seriya: Medicina. Farmaciya. 2019; 42(1): 65-72. https://doi:10.18413/2075-4728-2019-42-1-65-72 [in Russian]Михайлова А.А., Конева Е.С., Иванова И.И. Применение современных немедикаментозных техноло гий для улучшения качества жизни пациентов гемипарезом. Вопросы курортологии, физиотерапии и лечебной физической культуры. 2021; 98(6–2): 25–30. https://doi:10.17116/kurort20219806225Mikhailova A.A., Koneva E.S., Ivanova I.I. Application of modern non–drug technologies to improve the quality of life of patients with hemiparesis. Vopr Kurortol Fizioter Lech Fiz Kult. 2021; 98(6–2):25–30. https://doi:10.17116/kurort20219806225 [in Russian]Coleman E.R., Moudgal R., Lang K. et al. Early Rehabilitation After Stroke: a Narrative Review. Curr Atheroscler Rep. 2017 Nov 7; 19(12): 59. https://doi:10.1007/s11883–017–0686–6.Coleman E.R., Moudgal R., Lang K. et al. Early Rehabilitation After Stroke: a Narrative Review. Curr Atheroscler Rep. 2017 Nov 7; 19(12): 59. https://doi:10.1007/s11883–017–0686–6.Watson P.A., Gignac G.E., Weinborn M. et al. A Meta–Analysis of Neuropsychological Predictors of Outcome Following Stroke and Other Non–Traumatic Acquired Brain Injuries in Adults. Neuropsychol Rev. 2020; 30(2): 194–223. https://doi:10.1007/s11065–020–09433–9Watson P.A., Gignac G.E., Weinborn M. et al. A Meta–Analysis of Neuropsychological Predictors of Outcome Following Stroke and Other Non–Traumatic Acquired Brain Injuries in Adults. Neuropsychol Rev. 2020; 30(2): 194–223. https://doi:10.1007/s11065–020–09433–9Visvanathan A., Graham C., Dennis M. et al. Predicting specific abilities after disabling stroke: Development and validation of prognostic models. Int J Stroke. 2021; 16(8): 935–943. https://doi:10.1177/1747493020982873Visvanathan A., Graham C., Dennis M. et al. Predicting specific abilities after disabling stroke: Development and validation of prognostic models. Int J Stroke. 2021; 16(8): 935–943. https://doi:10.1177/1747493020982873Kunz W.G., Hunink M.G., Almekhlafi M.A. et al. Public health and cost consequences of time delays to thrombectomy for acute ischemic stroke. Neurology. 2020; 95(18): e2465–e2475. https://doi:10.1212/WNL.0000000000010867Kunz W.G., Hunink M.G., Almekhlafi M.A. et al. Public health and cost consequences of time delays to thrombectomy for acute ischemic stroke. Neurology. 2020; 95(18): e2465–e2475. https://doi:10.1212/WNL.0000000000010867Feigin V.L., Roth G.A., Naghavi M. et al. Global burden of stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2016; 15(9): 913–24. https://doi:10.1016/S1474–4422(16)30073–4Feigin V.L., Roth G.A., Naghavi M. et al. Global burden of stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2016; 15(9): 913–24. https://doi:10.1016/S1474–4422(16)30073–4Moskalenko M.I., Ponomarenko I.V., Zhernakova N.I. et al. The Role of the Stress Factor in Mediating the Genetic Predisposition to Stroke of the Background of Hypertensive Disease. Neuroscience and Behavioral Physiology. 2020; 50(2): 143-148. https://doi:10.1007/s11055019-00880-3.Moskalenko M.I., Ponomarenko I.V., Zhernakova N.I. et al. The Role of the Stress Factor in Mediating the Genetic Predisposition to Stroke of the Background of Hypertensive Disease. Neuroscience and Behavioral Physiology. 2020; 50(2): 143-148. https://doi:10.1007/s11055019-00880-3.Москаленко М.И., Пономаренко И.В., Полоников А.В., и др. Роль стрессового фактора в реализации генетической предрасположенности к развитию инсульта на фоне гипертонической болезни. Журнал неврологии и психиатрии им. С. С. Корсакова. Спецвыпуски. 2019; 119(3-2): 11-17. https://doi:10.17116/jnevro201911903211.EDN ASMGUW.Moskalenko MI, Ponomarenko IV, Polonikov AV et al. The role of stress factors and genetic predisposition in the development of stroke in patients with essential hypertension. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova . 2019; 119(3-2): 11-17. https://doi:10.17116/jnevro201911903211.EDN ASMGUW [in Russian].Вишневский В.И., Семенова Е.А. Использование дистанционного медицинского интернет-консультирования в амбулаторном ведении больных с артериальной гипертонией. Актуальные проблемы медицины. 2021; 44(1): 49-56. https://doi:10.52575/2687-0940-2021-44-1-49-56.Vishnevsky V.I., Semenova E.A. The use of tele-health internet counseling in the outpatient management of patients with arterial hypertension. Aktual’nye problemy mediciny. 2021; 44(1): 49-56. https://doi:10.52575/2687-0940-2021-44-1-49-56. [in Russian]Wang X., Tanna G.L.D., Moullaali T.J. et al. Online ahead of print. J–shape relation of blood pressure reduction and outcome in acute intracerebral hemorrhage: A pooled analysis of INTERACT2 and ATACH–II individual participant data. Int J Stroke. 2022; 5: 17474930211064076. https://doi:10.1177/17474930211064076Wang X., Tanna G.L.D., Moullaali T.J. et al. Online ahead of print. J–shape relation of blood pressure reduction and outcome in acute intracerebral hemorrhage: A pooled analysis of INTERACT2 and ATACH–II individual participant data. Int J Stroke. 2022; 5: 17474930211064076. https://doi:10.1177/17474930211064076de Havenon A., Bennett A., Stoddard G.J. et al. Determinants of the impact of blood pressure variability on neurological outcome after acute ischaemic stroke. Stroke Vasc. Neurol. 2017; 2(1): 1–6. https://doi:10.1136/svn–2016–000057de Havenon A., Bennett A., Stoddard G.J. et al. Determinants of the impact of blood pressure variability on neurological outcome after acute ischaemic stroke. Stroke Vasc. Neurol. 2017; 2(1): 1–6. https://doi:10.1136/svn–2016–000057Bath P.M., Appleton J.P., Krishnan K. et al. Blood Pressure in Acute Stroke. Stroke. 2018;49(7):1784–90. https://doi:10.1161/STROKEAHA.117.017228Bath P.M., Appleton J.P., Krishnan K. et al. Blood Pressure in Acute Stroke. Stroke. 2018;49(7):1784–90. https://doi:10.1161/STROKEAHA.117.017228He M., Wang H., Tang Y. et al. Blood pressure undulation of peripheral thrombolysis period in acute ischemic stroke is associated with prognosis. J Hypertens. 2022; Jan 3. Online ahead of print. https://doi:10.1097/HJH.0000000000003070He M., Wang H., Tang Y. et al. Blood pressure undulation of peripheral thrombolysis period in acute ischemic stroke is associated with prognosis. J Hypertens. 2022; Jan 3. Online ahead of print. https://doi:10.1097/HJH.0000000000003070de Havenon A., Bennett A., Stoddard G.J. et al. Increased Blood Pressure Variability Is Associated with Worse Neurologic Outcome in Acute Anterior Circulation Ischemic Stroke. Stro ke Res Treat. 2016; 8: 7670161. https://doi:10.1155/2016/7670161de Havenon A., Bennett A., Stoddard G.J. et al. Increased Blood Pressure Variability Is Associated with Worse Neurologic Outcome in Acute Anterior Circulation Ischemic Stroke. Stro ke Res Treat. 2016; 8: 7670161. https://doi:10.1155/2016/7670161Webb A., Mazzucco S., Li L., Rothwell P.M. Prognostic Significance of Blood Pressure Variability on Beat–to–Beat Monitoring After Transient Ischemic Attack and Stroke. Stroke. 2017; 49(1): 62–7. https://doi:10.1161/STROKEAHA.117.019107Webb A., Mazzucco S., Li L., Rothwell P.M. Prognostic Significance of Blood Pressure Variability on Beat–to–Beat Monitoring After Transient Ischemic Attack and Stroke. Stroke. 2017; 49(1): 62–7. https://doi:10.1161/STROKEAHA.117.019107Tan Z., Meng H., Dong D. et al. Blood pressure variability estimated by ARV is a predictor of poor short–term outcomes in a prospective cohort of minor ischemic stroke. PloS one. 2018; 13(8): e0202317. https://doi:10.1371/journal.pone.0202317Tan Z., Meng H., Dong D. et al. Blood pressure variability estimated by ARV is a predictor of poor short–term outcomes in a prospective cohort of minor ischemic stroke. PloS one. 2018; 13(8): e0202317. https://doi:10.1371/journal.pone.0202317Мирютова Н.Ф., Самойлова И.М., Минченко Н.Н. и др. Терапевтические эффекты зеркальной терапии у больных после инсульта. Вопросы курортологии, физиотерапии и лечебной физической культуры. 2021; 98(5): 14-23. https://doi:10.17116/kurort20219805114Miryutova N.F., Samoylova I.M., Minchenko N.N. et al. Therapeutic effects of mirror therapy in patients after stroke. Voprosy kurortologii, fizioterapii, i lechebnoi fizicheskoi kultury. 2021; 98(5): 14-23. https://doi:10.17116/kurort20219805114 [in Russian]Sibolt G., Curtze S., Jokinen H. et al. Post–stroke dementia and permanent institutionalization. J Neurol Sci. 2021; 421: 117307. https://doi:10.1016/j.jns.2020.117307Sibolt G., Curtze S., Jokinen H. et al. Post–stroke dementia and permanent institutionalization. J Neurol Sci. 2021; 421: 117307. https://doi:10.1016/j.jns.2020.117307Romain G., Romo L.M., Hol E.M. et al. From Stroke to Dementia: a Comprehensive Review Exposing Tight Interactions Between Stroke and Amyloid–β Formation. Transl Stroke Res. 2020; 11(4): 601–614. https://doi:10.1007/s12975–019–00755–2Romain G., Romo L.M., Hol E.M. et al. From Stroke to Dementia: a Comprehensive Review Exposing Tight Interactions Between Stroke and Amyloid–β Formation. Transl Stroke Res. 2020; 11(4): 601–614. https://doi:10.1007/s12975–019–00755–2Filipska K., Wiśniewski А., Biercewicz M. et al. Are Depression and Dementia a Common Problem for Stroke Older Adults? A Review of Chosen Epidemiological Studies. Psychiatr Q. 2020; 91(3): 807–817. https://doi:10.1007/s11126–020–09734–5Filipska K., Wiśniewski А., Biercewicz M. et al. Are Depression and Dementia a Common Problem for Stroke Older Adults? A Review of Chosen Epidemiological Studies. Psychiatr Q. 2020; 91(3): 807–817. https://doi:10.1007/s11126–020–09734–5Guo X., Östling S., Kern S. et al. Increased risk for dementia both before and after stroke: A population–based study in women followed over 44 years. Alzheimers Dement. 2018; 14(10): 1253–1260. https://doi:10.1016/j.jalz.2018.05.009Guo X., Östling S., Kern S. et al. Increased risk for dementia both before and after stroke: A population–based study in women followed over 44 years. Alzheimers Dement. 2018; 14(10): 1253–1260. https://doi:10.1016/j.jalz.2018.05.009Национальный стандарт Российской Федерации. Протокол ведения пациентов. Инсульт. Пункт 3.5-3.7 [Электронный ресурс]. URL: https://docs.cntd.ru/document/1200074382 (Дата обращения: 09.03.2022).National standard of the Russian Federation. Patient management protocol. Stroke. Р. 3.5-3.7 [Electronic resource]. URL: https://docs.cntd.ru/document/1200074382 (Date of the application: 09.03.2022) [in Russian]Клинические рекомендации. Артериальная гипертензия у взрослых. 2020: 19-20. [Электронный ресурс]. URL: https://scardio.ru/content/Guidelines/Clinic_rek_AG_2020.pdf (Дата обращения: 29.01.2022)Clinical guidelines. Ischemic stroke and transient ischemic attack in adults. 2022: 26-27. [Electronic resource]. URL: https://evidenceneurology.ru/content/downloadfiles/13/kr-po-ii-i-tia_2022_finalnii-v_ru_1650370148.pdf (Date of the application: 15.02.2022) [in Russian]Brott T., Adams H.P.J., Olinger C.P. et al. Measurements of acute cerebral infarction: A clinical examination scale. Stroke. 1989; 20: 864–70. https://doi:0.1161/01.STR.20.7.864Clinical guidelines. Arterial hypertension in adults. 2020: 19-20. [Electronic resource]. URL: https://scardio.ru/content/Guidelines/Clinic_rek_AG_2020.pdf (Date of the application: 29.01.2022) [in Russian]Фломин Ю.В. Клинические шкалы в неврологии: использование инсультной шкалы национальных институтов здоровья США для оценки тяжести инсульта и выбора лечебной тактики. Нейрон–ревю. 2013; 1: 15–24.Brott T., Adams H.P.J., Olinger C.P. et al. Measurements of acute cerebral infarction: A clinical examination scale. Stroke. 1989; 20: 864–70. https://doi:0.1161/01.STR.20.7.864Schlegel D., Kolb S.J., Luciano J.M. et al. Utility of the NIH Stroke Scale as a predictor of hospital disposition. Stroke. 2003; 34(1): 134–7. https://doi:10.1161/01.STR.0000048217.44714.02Flomin YuV. Clinical Scales in Neurology: Using the National Institutes of Health Stroke Scale for Stroke Severity and Treatment. Neuron revue. 2013; 1: 15–24. [in Russian]Mahoney F.I., Barthel D.W. Functional evaluation: The Barthel indeх. Md. State. Med. J. 1965; 14: 61–5.Schlegel D., Kolb S.J., Luciano J.M. et al. Utility of the NIH Stroke Scale as a predictor of hospital disposition. Stroke. 2003; 34(1): 134–7. https://doi:10.1161/01.STR.0000048217.44714.02Kasner S.E. Clinical interpretation and use of stroke scales. Lancet Neurol. 2006; 5(7): 603–12. https://doi:10.1016/S1474–4422(06)70495–1Mahoney F.I., Barthel D.W. Functional evaluation: The Barthel indeх. Md. State. Med. J. 1965; 14: 61–5.Bennett AE, Wilder MJ, McNally JS, et al. Increased blood pressure variability after endovascular thrombectomy for acute stroke is associated with worse clinical outcomeJournal of NeuroInterventional Surgery 2018; 10: 823-827. https://doi:10.1136/neurintsurg-2017-013473Kasner S.E. Clinical interpretation and use of stroke scales. Lancet Neurol. 2006; 5(7): 603–12. https://doi:10.1016/S1474–4422(06)70495–1Rothwell PM, Howard SC, Dolan E, et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet. 2010; 375: 895–905.Bennett AE, Wilder MJ, McNally JS, et al. Increased blood pressure variability after endovascular thrombectomy for acute stroke is associated with worse clinical outcomeJournal of NeuroInterventional Surgery 2018; 10: 823-827. https://doi:10.1136/neurintsurg-2017-013473Duncombe J, Kitamura A, Hase Y, et al. Chronic cerebral hypoperfusion: a key mechanism leading to vascular cognitive impairment and dementia: closing the translational gap between rodent models and human vascular cognitive impairment and dementia. Clin Sci (Lond). 2017; 131: 2451–2468.Rothwell PM, Howard SC, Dolan E, et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet. 2010; 375: 895–905.Ma Y, Tully PJ, Hofman A, et al. Blood Pressure Variability and Dementia: A State-of-the-Art Review. American Journal of Hypertension. 2020; 33(12): 1059–1066. https://doi:10.1093/ajh/hpaa119Duncombe J, Kitamura A, Hase Y, et al. Chronic cerebral hypoperfusion: a key mechanism leading to vascular cognitive impairment and dementia: closing the translational gap between rodent models and human vascular cognitive impairment and dementia. Clin Sci (Lond). 2017; 131: 2451–2468.Tully PJ, Yano Y, Launer LJ, et al. Association Between Blood Pressure Variability and Cerebral Small-Vessel Disease: A Systematic Review and Meta-Analysis and the Variability in Blood Pressure and Brain Health Consortium. Journal of the American Heart Association. 2020;9:e013841 https://doi:10.1161/JAHA.119.013841Ma Y, Tully PJ, Hofman A, et al. Blood Pressure Variability and Dementia: A State-of-the-Art Review. American Journal of Hypertension. 2020; 33(12): 1059–1066. https://doi:10.1093/ajh/hpaa119Tully PJ, Yano Y, Launer LJ, et al. Association Between Blood Pressure Variability and Cerebral Small-Vessel Disease: A Systematic Review and Meta-Analysis and the Variability in Blood Pressure and Brain Health Consortium. Journal of the American Heart Association. 2020;9:e013841 https://doi:10.1161/JAHA.119.013841Tully PJ, Yano Y, Launer LJ, et al. Association Between Blood Pressure Variability and Cerebral Small-Vessel Disease: A Systematic Review and Meta-Analysis and the Variability in Blood Pressure and Brain Health Consortium. Journal of the American Heart Association. 2020;9:e013841 https://doi:10.1161/JAHA.119.013841

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