Olmesartan Improves Cerebral Hemodynamic and Neurologic Outcomes in Elderly Patients with Hypertension and Ischemic Stroke
Background. In patients with hypertension there is a violation of autoregulation of cerebral hemodynamics. When conducting antihypertensive therapy, it is important to choose such targets for pressure reduction and such antihypertensive agents, which will not impair the blood supply to the brain.
The results of the research. Studies have demonstrated that olmesartan completely restores the cerebral blood flow in elderly patients with hypertension and cerebral hypoperfusion. In contrast to amlodipine, olmesartan increases the cerebral blood flow in the affected (by 15.5 %) and health (by 9.2 %) hemispheres in elderly patients with hypertension and ischemic stroke, increases the value of cerebrovascular reserve in the affected hemisphere (by 55%) in the same group of patients. Due to these effects, more pronounced recovery of neurological function by Brunnstrom scale is observed among patients treated with olmesartan: severity of hemiplegia was decreased by 50 % (in the group with amlodi-pine — by 17.4 %).
Mechanisms. It is assumed that the ability of olmesartan to normalize autoregulation of cerebral circulation is associated with the possessing of anti-inflammatory and antioxidant effects in the wall of the brain arterioles due to direct blockade of the AT1-receptors.
Modes of treatment. Based on current recommendations in most cases olmesartan therapy as any other antihypertensives must begin in a few weeks after the acute phase of ischemic stroke.
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Strandgaard S. Autoregulation of cerebral blood flow in hypertensive patients. The modifying influence of prolonged antihypertensive treatment on the tolerance to acute, drug-induced hypotension // Circulation. — 1976. — V. 53, № 4. — P. 720-727.
Lassen N.A. Cerebral blood flow and oxygen consumption in man // Physiol. Rev. — 1959. — V. 39, № 2. — P. 183-238.
Autoregulation of Brain Circulation in Severe Arterial Hypertension / Strandgaard S., Olesen J., Skinhøj E., Lassen N.A. // Br. Med. J. — 1973. — V. 1(5852). — P. 507-510.
2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) / Mancia G., Fagard R., Narkiewicz K., Redón J. et al. // J. Hypertens. — 2013. — V. 31, № 7. — P. 1281-1357.
Jordan J.D., Powers W.J. Cerebral autoregulation and acute ischemic stroke // Am. J. Hypertens. — 2012. — V. 25, № 9. — P. 946-950.
Nagata R., Kawabe K., Ikeda K. Olmesartan, an angiotensin II receptor blocker, restores cerebral hypoperfusion in elderly patients with hypertension // J. Stroke Cerebrovasc. Dis. — 2010. — V. 19, № 3. — P. 236-240.
Benefits of the angiotensin II receptor antagonist olmesartan in controlling hypertension and cerebral hemodynamics after stroke / Matsumoto S., Shimodozono M., Miyata R., Kawahira K. // Hypertens. Res. — 2009. — V. 32, № 11. — P. 1015-1021.
Losartan, an angiotensin II (AT1) receptor antagonist, preserves cerebral blood flow in hypertensive patients with a history of stoke / Moriwaki H., Uno H., Nagakane Y. et al. // J. Hum. Hypertens. — 2004. — V. 18. — P. 693-699.
Protection against ischemia and improvement of cerebral blood flow in genetically hypertensive rats by chronic pretreatment with an angiotensin II AT1 antagonist / Ito T., Yamakawa H., Bregonzio C. et al. // Stroke. — 2002. — V. 33. — P. 2297-2303.
Fliser D., Buchholz K., Haller H. European Trial on Olme-sartan and Pravastatin in Inflammation and Atherosclerosis (EUTOPIA) Investigators. Antiinflammatory effects of angiotensin II subtype 1 receptor blockade in hypertensive patients with microinflammation // Circulation. — 2004. — V. 110. — P. 1103-1107.
Blockade of angiotensin II type-1 receptor reduces oxidative stress in adipose tissue and ameliorates adipocytokine dysregulation / Kurata A., Nishizawa H., Kihara S. et al. // Kidney Int. — 2006. — V. 70. — P. 1717-1724.
Inhibitory effects of AT1 receptor blocker, olmesartan, and estrogen on atherosclerosis via anti-oxidative stress / Tsuda M., Iwai M., Li J.M. // Hypertension. — 2005. — V. 45. — P. 545-551.
Patarroyo S.X.F., Anderson C. Blood pressure lowering in acute phase of stroke: latest evidence and clinical implications // Ther. Adv. Chronic Dis. — 2012. — V. 3, № 4. — P. 163-171.
Spengos K., Tsivgoulis G., Zakopoulos N. Blood pressure management in acute stroke: a long-standing debate // Eur. Neurol. — 2006. — V. 55, № 3. — P. 123-135.
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