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Значение артериальной гипертензии в развитии поражения головного мозга – от легких когнитивных нарушений к деменции
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Аннотация
Проблема нарушений когнитивных функций у пациентов с соматическими заболеваниями сегодня занимает ведущую позицию, поскольку представляет собой одно из наиболее распространенных проявлений органического поражения головного мозга. Роль артериальной гипертензии (АГ) в формировании когнитивных нарушений (КН) была показана в крупных эпидемиологических исследованиях. КН выявляются у 73% пациентов как среднего, так и пожилого возраста с длительностью АГ более 5 лет. Раннее выявление потенциально излечимых когнитивных расстройств – одна из важных задач современного врача-терапевта, кардиолога, эндокринолога, семейного врача, поскольку пациенты на ранних стадиях КН составляют большинство из обратившихся за помощью. В современном мире часто действия врачей первичного звена являются определяющими в прогнозе развития деменции, так как выявление ранних недементных форм КН и своевременное адекватное лечение сердечно-сосудистой патологии, в первую очередь АГ, часто вполне достаточно, чтобы выраженность КН у пациента значимо уменьшилась, а деменция никогда не наступила.
Ключевые слова: когнитивные нарушения, деменция, артериальная гипертензия, лозартан, амлодипин.
Ключевые слова: когнитивные нарушения, деменция, артериальная гипертензия, лозартан, амлодипин.
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The problem of cognitive impairment in patients with somatic diseases today occupies a leading position, as it represents one of the most widespread manifestations of organic brain damage. The role of arterial hypertension (AH) in the formation of cognitive impairment (CI) has been shown in large epidemiological studies. CI detected in 73% of patients of both middle and senior age with hypertension duration of more than 5 years. Early detection of potentially treatable cognitive disorders is one of the most important tasks of the modern practitioner, cardiologist, endocrinologist, family doctor, as the patients in the early stages of CI constitute the majority of people seeking help. In today's world, primary care physicians' actions are often crucial in the prediction of dementia, since the detection of early forms of non-dementia CI and timely and adequate treatment of cardiovascular disease, especially hypertension, is often enough for the severity of the CI patients was significantly decreased, and dementia never came.
Key words: cognitive disorders, dementia, arterial hypertension, losartan, amlodipine.
Полный текст
Список литературы
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12. Elias MF, Wolf PA, D`Agostino et al. Untreated blood pressure level is inversely reated to cognitive functioning: the Framingham Study. Am J Epidemiol 1993; 138 (6): 353–64.
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14. Ruitenberg A, Skoog I, Ott A et al. Blood pressure and risk of dementia: results from the Rotterdam study and the Gothenburg H-70 Study. Dement Geriatr Cogn Disord 2001; 12 (1): 33–9.
15. Launer LJ, Masaki K, Petrovitch H et al. The association between midlife blood pressure level and late-life cognitive function. The Honolulu–Asia Aging Study. JAMA 1995; 274 (23): 1846–51.
16. Danlof B, Devereux RB, Kieldsen SE et al for the LIFE study group. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359: 995–1003.
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21. Lithell H, Hansson L, Skoog I et al for the SCOPE Study Group. The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial. Hypertension 2003; 21: 875–6.
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24. Tedesco MA, Ratti G, Mennella G et al. Comparison of losartan and hydrochloroth-iazide on cognitive function and quality of life in hypertensive patients. Am J Hypertens 1999; 12: 1130–4.
25. Fogari R, Mugellini A. Influence of losartan and atenolol on memory function in very elderly hypertensive patients. J Hum Hypertension 2003; 17: 781–5.
26. Schrader J et al. Effects of long-term antihypertensive therapy with losartan on blood pressure and cognitive function in patients with essential hypertension and other cerebrovascular risk factors (AWARE observational study) Med Klin (Munich) 2008; 103 (7): 491–9.
27. Hanon O. Effects of Antihypertensive Therapy on Cognitive Decline in Alzheimer's N Engl J Med 2003; 348: 1333–41.
28. Braszko J. The contribution of AT1 and AT2 angiotensin receptors to its cognitive effects. Acta Neirobiol Exp 1996; 56: 49–54.
29. Wright JW, Harding JW. The angiotensin AT4 receptor subtype as a target for the treatment of memory dysfunction associated with Alzheimers disease. J Renin Angiotensin Aldosterone Syst 2008; 9: 226–37.
30. Hanon O, Pequignot R. Relationship between antihypertensive drug therapy and cognitive function in elderly hypertensive patients with memory complaints. J Hypertens 2006; 24 (10): 2101–7.
31. Zeng F. Adherence and persistence of single-pill ARB/CCB combination therapy compared to multiple-pill ARB/CCB regimens. Curr Med Res Opin 2010; 26 (12): 2877–87.
32. Coca A. Ambulatory Blood Pressure in Stroke and Cognitive Dysfunction. Curr Hypertens Rep 2013; 15: 150–9.
2. Ferri CP, Prince M. Global prevalence of dementia: a Delphi consensus study. Lancet 2005; 366 (9503): 2112–7.
3. Суслина З.А., Варакин Ю.Я., Верещагин Н.В. Сосудистые заболевания головного мозга: Эпидемиология. Основы профилактики. М.: МЕДпресс-информ, 2009.
4. Гусев Е.И., Боголепова А.Н. Когнитивные нарушения при цереброваскулярных заболеваниях. М.: МЕДпреcс-информ, 2013.
5. Гусев Е.И., Скворцова В.И. Ишемия головного мозга. М.: Медицина, 2001.
6. Левин О.С. Диагностика и лечение деменции в клинической практике. М.: МЕДпресс-информ, 2010.
7. Яхно Н.Н. Когнитивные расстройства в неврологической клинике. Неврол. журн. 2006; 11 (Прил. 1): 4–12.
8. Petersen RS, Smith GE, Waring SC et al. Mild cognitive impairement: clinical characterization and outcome. Arch Neurol 1999; 56: 303–8.
9. Petersen RC. Mild cognitive impairment as a diagnostic entity. J Int Med 2004; 256: 183–94.
10. Дамулин И.В. Легкие когнитивные нарушения. Cons. Med. 2004; 2: 138–41.
11. Преображенская И.С. Легкие и умеренные когнитивные нарушения – клинические проявления, этиология, патогенез, возможности использования ноотропной терапии. Спецвыпуск: Психиатрия. Неврология. Фарматека, 2013; 4: 14–8.
12. Elias MF, Wolf PA, D`Agostino et al. Untreated blood pressure level is inversely reated to cognitive functioning: the Framingham Study. Am J Epidemiol 1993; 138 (6): 353–64.
13. Tzourio C, Dufouil C, Ducimetiere P et al. Cognitive decline in individuals with high blood pressure: a longitudinal study in the elderly. EVA Study Group. Epidemiology of Vascular Aging. Neurology 1999; 53 (9): 1948–52.
14. Ruitenberg A, Skoog I, Ott A et al. Blood pressure and risk of dementia: results from the Rotterdam study and the Gothenburg H-70 Study. Dement Geriatr Cogn Disord 2001; 12 (1): 33–9.
15. Launer LJ, Masaki K, Petrovitch H et al. The association between midlife blood pressure level and late-life cognitive function. The Honolulu–Asia Aging Study. JAMA 1995; 274 (23): 1846–51.
16. Danlof B, Devereux RB, Kieldsen SE et al for the LIFE study group. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359: 995–1003.
17. Sierra C, de la Sierra A. Antihypertensive, cardiovascular, and pleiotropic effects of angiotensin-receptor blockers. Curr Opin Nephrol Hypertens 2005; 14: 435–41.
18. Hernandez RH, Armas-Hernandez MJ, Velasco M. Calcium antagonists and atherosclerosis protection in hypertension. Am J Ther 2003; 10 (6): 409–14.
19. Mancini GBJ, Michael E Miller, Ward Riley (for the PREVENT Investigators) Effect of Amlodipine on the Progression of Atherosclerosis and the Occurrence of Clinical Events. Circulation 2000; 102: 1503–10.
20. Forette F, Seux ML. The prevention of dementia with antihypertensive treatment: new evidence from the systolic hypertension in europe (syst-eur) study. Arch Intern Med 2002; 162 (18): 2046–52.
21. Lithell H, Hansson L, Skoog I et al for the SCOPE Study Group. The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial. Hypertension 2003; 21: 875–6.
22. Schrader J, Luders S, Kulschewski A et al. Morbidity and Mortality after Stroke, Eprosartan Compared with Nitrendipine for Secondary Prevention: principal results of a prospective randomized controlled study (MOSES). Stroke 2005; 36: 1218–26.
23. Diener HC, Sacco R, Yusuf S. Rationale, design and baseline data of a randomized, double-blind, controlled trial comparing two antithrombotic regimens (a fixed-dose combination of extended-release dipyridamole plus ASA with clopidogrel) and telmisartan versus placebo in patients with strokes: the Prevention Regimen for Effectively Avoiding Second Strokes trial (PRoFESS). Cerebrovasc Dis 2007; 23: 368–80.
24. Tedesco MA, Ratti G, Mennella G et al. Comparison of losartan and hydrochloroth-iazide on cognitive function and quality of life in hypertensive patients. Am J Hypertens 1999; 12: 1130–4.
25. Fogari R, Mugellini A. Influence of losartan and atenolol on memory function in very elderly hypertensive patients. J Hum Hypertension 2003; 17: 781–5.
26. Schrader J et al. Effects of long-term antihypertensive therapy with losartan on blood pressure and cognitive function in patients with essential hypertension and other cerebrovascular risk factors (AWARE observational study) Med Klin (Munich) 2008; 103 (7): 491–9.
27. Hanon O. Effects of Antihypertensive Therapy on Cognitive Decline in Alzheimer's N Engl J Med 2003; 348: 1333–41.
28. Braszko J. The contribution of AT1 and AT2 angiotensin receptors to its cognitive effects. Acta Neirobiol Exp 1996; 56: 49–54.
29. Wright JW, Harding JW. The angiotensin AT4 receptor subtype as a target for the treatment of memory dysfunction associated with Alzheimers disease. J Renin Angiotensin Aldosterone Syst 2008; 9: 226–37.
30. Hanon O, Pequignot R. Relationship between antihypertensive drug therapy and cognitive function in elderly hypertensive patients with memory complaints. J Hypertens 2006; 24 (10): 2101–7.
31. Zeng F. Adherence and persistence of single-pill ARB/CCB combination therapy compared to multiple-pill ARB/CCB regimens. Curr Med Res Opin 2010; 26 (12): 2877–87.
32. Coca A. Ambulatory Blood Pressure in Stroke and Cognitive Dysfunction. Curr Hypertens Rep 2013; 15: 150–9.
________________________________________________
1. Захаров В.В., Яхно Н.Н. Когнитивные расстройства в пожилом и старческом возрасте. Методическое пособие для врачей. М., 2005.
2. Ferri CP, Prince M. Global prevalence of dementia: a Delphi consensus study. Lancet 2005; 366 (9503): 2112–7.
3. Суслина З.А., Варакин Ю.Я., Верещагин Н.В. Сосудистые заболевания головного мозга: Эпидемиология. Основы профилактики. М.: МЕДпресс-информ, 2009.
4. Гусев Е.И., Боголепова А.Н. Когнитивные нарушения при цереброваскулярных заболеваниях. М.: МЕДпреcс-информ, 2013.
5. Гусев Е.И., Скворцова В.И. Ишемия головного мозга. М.: Медицина, 2001.
6. Левин О.С. Диагностика и лечение деменции в клинической практике. М.: МЕДпресс-информ, 2010.
7. Яхно Н.Н. Когнитивные расстройства в неврологической клинике. Неврол. журн. 2006; 11 (Прил. 1): 4–12.
8. Petersen RS, Smith GE, Waring SC et al. Mild cognitive impairement: clinical characterization and outcome. Arch Neurol 1999; 56: 303–8.
9. Petersen RC. Mild cognitive impairment as a diagnostic entity. J Int Med 2004; 256: 183–94.
10. Дамулин И.В. Легкие когнитивные нарушения. Cons. Med. 2004; 2: 138–41.
11. Преображенская И.С. Легкие и умеренные когнитивные нарушения – клинические проявления, этиология, патогенез, возможности использования ноотропной терапии. Спецвыпуск: Психиатрия. Неврология. Фарматека, 2013; 4: 14–8.
12. Elias MF, Wolf PA, D`Agostino et al. Untreated blood pressure level is inversely reated to cognitive functioning: the Framingham Study. Am J Epidemiol 1993; 138 (6): 353–64.
13. Tzourio C, Dufouil C, Ducimetiere P et al. Cognitive decline in individuals with high blood pressure: a longitudinal study in the elderly. EVA Study Group. Epidemiology of Vascular Aging. Neurology 1999; 53 (9): 1948–52.
14. Ruitenberg A, Skoog I, Ott A et al. Blood pressure and risk of dementia: results from the Rotterdam study and the Gothenburg H-70 Study. Dement Geriatr Cogn Disord 2001; 12 (1): 33–9.
15. Launer LJ, Masaki K, Petrovitch H et al. The association between midlife blood pressure level and late-life cognitive function. The Honolulu–Asia Aging Study. JAMA 1995; 274 (23): 1846–51.
16. Danlof B, Devereux RB, Kieldsen SE et al for the LIFE study group. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359: 995–1003.
17. Sierra C, de la Sierra A. Antihypertensive, cardiovascular, and pleiotropic effects of angiotensin-receptor blockers. Curr Opin Nephrol Hypertens 2005; 14: 435–41.
18. Hernandez RH, Armas-Hernandez MJ, Velasco M. Calcium antagonists and atherosclerosis protection in hypertension. Am J Ther 2003; 10 (6): 409–14.
19. Mancini GBJ, Michael E Miller, Ward Riley (for the PREVENT Investigators) Effect of Amlodipine on the Progression of Atherosclerosis and the Occurrence of Clinical Events. Circulation 2000; 102: 1503–10.
20. Forette F, Seux ML. The prevention of dementia with antihypertensive treatment: new evidence from the systolic hypertension in europe (syst-eur) study. Arch Intern Med 2002; 162 (18): 2046–52.
21. Lithell H, Hansson L, Skoog I et al for the SCOPE Study Group. The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial. Hypertension 2003; 21: 875–6.
22. Schrader J, Luders S, Kulschewski A et al. Morbidity and Mortality after Stroke, Eprosartan Compared with Nitrendipine for Secondary Prevention: principal results of a prospective randomized controlled study (MOSES). Stroke 2005; 36: 1218–26.
23. Diener HC, Sacco R, Yusuf S. Rationale, design and baseline data of a randomized, double-blind, controlled trial comparing two antithrombotic regimens (a fixed-dose combination of extended-release dipyridamole plus ASA with clopidogrel) and telmisartan versus placebo in patients with strokes: the Prevention Regimen for Effectively Avoiding Second Strokes trial (PRoFESS). Cerebrovasc Dis 2007; 23: 368–80.
24. Tedesco MA, Ratti G, Mennella G et al. Comparison of losartan and hydrochloroth-iazide on cognitive function and quality of life in hypertensive patients. Am J Hypertens 1999; 12: 1130–4.
25. Fogari R, Mugellini A. Influence of losartan and atenolol on memory function in very elderly hypertensive patients. J Hum Hypertension 2003; 17: 781–5.
26. Schrader J et al. Effects of long-term antihypertensive therapy with losartan on blood pressure and cognitive function in patients with essential hypertension and other cerebrovascular risk factors (AWARE observational study) Med Klin (Munich) 2008; 103 (7): 491–9.
27. Hanon O. Effects of Antihypertensive Therapy on Cognitive Decline in Alzheimer's N Engl J Med 2003; 348: 1333–41.
28. Braszko J. The contribution of AT1 and AT2 angiotensin receptors to its cognitive effects. Acta Neirobiol Exp 1996; 56: 49–54.
29. Wright JW, Harding JW. The angiotensin AT4 receptor subtype as a target for the treatment of memory dysfunction associated with Alzheimers disease. J Renin Angiotensin Aldosterone Syst 2008; 9: 226–37.
30. Hanon O, Pequignot R. Relationship between antihypertensive drug therapy and cognitive function in elderly hypertensive patients with memory complaints. J Hypertens 2006; 24 (10): 2101–7.
31. Zeng F. Adherence and persistence of single-pill ARB/CCB combination therapy compared to multiple-pill ARB/CCB regimens. Curr Med Res Opin 2010; 26 (12): 2877–87.
32. Coca A. Ambulatory Blood Pressure in Stroke and Cognitive Dysfunction. Curr Hypertens Rep 2013; 15: 150–9.
Авторы
В.Н.Шишкова
ГУЗ Центр патологии речи и нейрореабилитации, Москва
ГУЗ Центр патологии речи и нейрореабилитации, Москва
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V.N.Shishkova
Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.