Ukrainian break-through in the European and World strategy of individual prophylaxis of an ischemic stroke in patients with arterial hypertension
Tolstopyatov S.M.
Today without new laboratory technology and new tactics of individual primary and secondary prevention of an ischemic stroke it is impossible decrease death rate of people.the conclusion of prof. Marrku Kaste (Stroke, 2010, 41: 2 449) death rate from a stroke above, than from a tuberculosis, AIDS and a malaria taken together. the USA stroke is registered everyone 40 sec (795000 in a year). Under assumption R.J. Gibbons et al. (Circulation, 2008, 118) mortality from an ischemic stroke in USA will increased by 100% with +2000 to 2032. The negative statistics, confirming existing catastrophe in prevention and treatment (V. Hachinsky - Stroke, 2008, 39: 2409 - stroke: a preventable and treatable catastrophe), specifies also in that fact, that public health services not in a condition to offer a way and the program for decrease in strokes and their risk (DC Goff et al., 2007) .the analysis information about traditional risk factors it has been established, that they do not allow to explain a cause of the general burden of strokes in population (AJ Grau et al. - Arch. Neurol., 2010,67 (1): 16-17) and, possibly , therefore in last recommendations they are not applied to identification and therapeutic influence at low and moderate risk (F. Zannad et al. - Eur. J. of Preventive Cardiology, 2012, 19 (5): 5-6) .the decision of the social problem a number of authors inform, that a cause of an ischemic stroke is formation of a clot of blood which blocks a blood-vesels in a brain (JS Paikin et al.- Circulation, +2012, 125: e439-e442), and a clinical predictor of a thrombosis is dysfunction of coagulation and anticoagulation systems of blood towards a hypercoagulable state and fibrinolysis depression (B. Siagerine et al., - Circulation, 2010; AI Shafer et al. - Hematology, +2003 v. 2; BM Ridker et al. - Circulation, +2004, 109; CD Bushnell et al.-Stroke, 2002, 33; KA Bauer et al.-Hematology, 2002, 1: 363; BM Coul - Stroke, 2004), and a key therapeutic principle of prevention of a stroke should be inhibition of coagulation (J. Steffel et al. - Eur. Heart. J., +2009, 30: 2832-2834). a number of authors it is established, that the recommended markers of coagulation system seldom reveal a haemostatic risk factor even at acute coronary syndrome and an ischemic stroke (Boss MJ et al - Circulation 2006, 114 1591; Bushnell CD et al. - Stroke , 2000, 31: 3 067; Cocho D. et al.-Stroke 2006, 37: 996; Derhasching FE et al. - Clinical Chemistry, +2002, 48: 1924; Leira EC et al. - Cerebrovasc. Disease, 2004, 18 ( 2: 139); Walenya JM et al, - Seminar Thromb. Haemost., 2 004, 50: 683). Therefore Guy De Baccer et al. (Eur.Journ. Of Preventive Cardiology, 2012; 19 (52): 114-117) wrote that estimation of an individuals cardiovascular risk remains approximate and the addition of new risk factors has disappointingly small effects.often the stroke develops in patients with hypertension and ischemic heart disease. ischemic stroke heart hypertension ischemic stroke most often develops at an arterial hypertension (АH) and ischemic heart disease. At XVI European conference on a hypertension (2006, Madrid) under the initiative prof. Thomas Giles (USA) the decision to consider АH as a complex cardiovascular pathology at which urgency and aggression of treatment should be in a context of individual overall risk, instead of simple decrease the blood pressure (BP) was accepted. According to the literature at АH not only the BP raises, but also is frequent (61,9% - my data) develop Birmingham paradox which is connected with infringement of biomarkers of the coagulation cascade and system of the fibrinolysis, clinically shown in the form of transitory ischemic attack or an ischemic stroke. The key thesis of conference became the requirement to treat in a clinical practice earlier and more aggressively. 7 years became obvious, that experts have not developed effective pathogenetic indicators for revealing clinical overall risk, and tactics of treatment still has been directed only on decrease the BP. New concept about АH and effective approaches to an individual prevention of ischemic stroke have not found reflection even in materials +2013 ESH/ESC Guidelines. The dramatic nature of a situation is burdened with the information, that traditional risk factors (blood pressure, total serum cholesterol, and smoking status) in short-term risk (0-10 years) and in long-term risk (0-35 years ) can not effectively be used to predict of a stroke (Kok Wai Glang et al.-Eur. Heart J., 2013, 34 (14): 1068). a pathogenesis of an ischemic stroke, we have developed the qualitative program ...
