Features of cerebroprotective efficacy of antihypertensive drugs according to neuroimaging studies

Purpose of the study was to elucidate the effects of treatment with calcium antagonists and beta-blockers on the dynamics of circadian blood pressure profile and changes of the severity of hypertensive encephalopathy according to magnetic resonance imaging (mRI) and dynamic x-ray computed tomography of the brain (DRKT). The study involved 100 patients with essential hypertension stage II, the average age of 51.0+9.5 years. Forty seven patients received Metoprolol (egilok retard, Egis, Hungary) at a dose of 25-100 mg; 29 patients received felodipine (felodip, IVAX, Czech Republic) 2.5-15 mg; and 24 patients were administered with verapamil (Isoptin SR 240, Knoll, Germany) 120-480 mg. At baseline and 6 months after the treatment, all patients underwent ABPM, MRI, and DRKT of the brain with the calculation of indicators of cerebral blood flow. The treatment with felodipine and verapamil led to a significant decrease in the periventricular and subcortical edema; treatment with metoprolol significantly decreased subcortical edema. The treatment with felodipine significantly improved cerebral perfusion; therapy with metoprolol and verapamil was associated with a tendency to increase cerebral blood flow in the area of periventricular edema. The maximum increase in cerebral blood flow was observed when systolic blood pressure decreased by 16-25 mm Hg compared with baseline. Felodipine exerted the best effects changing cerebral blood flow and decreasing the severity of the structural changes in hypertensive encephalopathy. The drug is indicated in patients with the initially reduced rates of cerebral blood flow and severe periventricular and subcortical cerebral edema. In patients with normal rates of cerebral blood flow and the presence of periventricular and subcortical edema, verapamil may be used. In patients with normal baseline blood flow and small subcortical edema, administration of metoprolol is justified.