Clinical Neuroscience

[The effect of hypertension and it’s therapy on cognitive performance of asymptomatic hypertensive patients]

CSIBA László, KOVÁCS Katalin Réka

MAY 30, 2013

Clinical Neuroscience - 2013;66(05-06)

[The essential hypertension increases the risk of cognitive impairment even in symptom-free patients. Sixty, non-treated hypertensives were investigated (44±10.5 év) with nine pszichological tests, measuring the reaction time, attention, short and long-term memory, psychomotor speed etc. The results of nine tests were summarized and compared with those of age-matched control persons (n=98). All hypertensives had normal CT findings. The carotid intima-media-thickness, the arterial stiffness and the velocities in the middle cerebral arteries were also analyzed (with tilting table test). The sum of the results of cognitive tests was significantly worse than that of controls 14.8±7.1 vs. 27.8±5.5 p<0.0001. The results of intima-media thickness and stiffness measurements were also significantly worse compared with controls while the middle cerebral velocities did not differ. After one year antihypertensive therapy not only the improvement of blood pressure, intima-media thickness and stiffness values could be detected but also the the score of summarized cognitive tests improved (from 17.4±6.0 to 31.6±6.0 p<0.0001).]



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[Non-valvular AF is the most common cardiac arrhytmia. Its incidence increases with age. AF is an independent risk factor for ischaemic stroke, representing a five times higher risk for it, associated with a high mortality rate. Beside AF, there are several other risk factors which influence the risk of stroke. Stroke risk calculator can be used to assess the risk of patient having a stroke. The most endangered group of patients with AF are those who have already suffered from cerebrovascular event. The only effective medication for prevention of stroke due to AF had been the application of vitamin K antagonists (VKA) which considerably decrease the rate of ischaemic event in a patient with AF providing that the INR is in the therapeutic range. VKA have several limitations of use in clinical practice and the fear of bleeding complications results an underusing of these drugs. Only 50% of all patients treated with VKA reaches the therapeutic range of INR. The breakthrough of prevention of stroke in recent years is undisputedly the coming out of novel oral anticoagulants (NOACs, thrombin and Xa-factor inhibitors). Recent studies suggest that these novel drugs prove the same efficacy as VKA drugs, furthermore dabigatran in a dose of 2×150 mg or apixaban in 2×5mg was statistically superior to warfarin in the prevention of stroke. NOACs have shown a large reduction in intracranial hemorrhage compared with warfarin. They are given as a fixed dose and do not require persistent monitoring making them much more convenient. NOACs at guidelines of European Society of Cardiology act as a preferable drugs in case of ischaemic stroke with AF. Probably the extended use of NOACs in clinical practice will be the mainstream of stroke prevention in the future.]

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