State of intra- and extracranial arteries, white matter and cerebral cortex in asymptomatic hypertensive patients

Aim. To assess the state of intra- and extracranial arteries, white matter and cerebral cortex in asymptomatic hypertensive (HTN) patients according to multimodal examination.

Material and methods. The study included data from 147 asymptomatic individuals (without prior ischemic stroke) with an established HTN (n=43; 29,3%) and without it. All participants underwent extracranial duplex ultrasound, transcranial duplex sonography, detection of middle cerebral artery microembolism, and brain magnetic resonance imaging. We performed a statistical analysis of the data obtained, adjusted for age and body mass index.

Results. In patients with HTN, atherosclerotic plaques were more often detected — 37,2 vs 14,4% on the right (p=0,027) and 41,9 vs 13,5% on the left (p=0,001). In these patients, intima-media abnormalities and common carotid artery narrowing were also more common. Regional temporal lobe atrophy (p=0,044 on the right and p=0,046 on the left), central atrophy (p=0,045), focal periventricular white matter abnormalities (p=0,004) were more pronounced in hypertensive patients. There was no association between HTN and the presence of cerebral microbleeds, as well as the Montreal Cognitive Assessment (MoCA) score.

Conclusion. In asymptomatic hypertensive patients relative to those without HTN, with comparable body mass index and age, head arterial abnormalities are more pronounced, but this regards only large ones — the common carotid artery. In these patients, more pronounced white matter and cerebral cortex changes were revealed.

1. Katakami N. Mechanism of development of atherosclerosis and cardiovascular disease in diabetes mellitus. J Atheroscl Thromb. 2018;25:27-39. doi:10.5551/jat.RV17014.

2. Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010;9:689-701. doi:10.1016/S1474-4422(10)70104-6.

3. Maksimova MY, Gulevskaya TS. Lacunar stroke. Zhurnal Nevrol i Psihiatr Im SS Korsakova. 2019;119(8):13-27. (In Russ.) doi:10.17116/jnevro201911908213.

4. Conijn MMA, Kloppenborg RP, Algra A, et al. Cerebral Small Vessel Disease and Risk of Death, Ischemic Stroke, and Cardiac Complications in Patients With Atherosclerotic Disease. Stroke. 2011;42(11):3105-9. doi:10.1161/STROKEAHA.110.594853.

5. Liu Y, Dong YH, Lyu PY, et al. Hypertension-Induced Cerebral Small Vessel Disease Leading to Cognitive Impairment. Chin Med J (Engl). 2018;131(5):615-9. doi:10.4103/0366-6999.226069.

6. Meissner A. Hypertension and the brain: A risk factor for more than heart disease. Cerebrovascular Diseases. 2016;42:255-62. doi:10.1159/000446082.

7. Lonardo A, Nascimbeni F, Mantovani A, Targher G. Hypertension, diabetes, atherosclerosis and NASH: Cause or consequence? J Hepatol. 2018;68:335-52. doi:10.1016/j.jhep.2017.09.021.

8. Ungvari Z, Tarantini S, Kirkpatrick AC, et al. Cerebral microhemorrhages: Mechanisms, consequences, and prevention. Am J Physiol Heart Circ Physiol. 2017;312:H1128-43. doi:10.1152/ajpheart.00780.2016.

9. Kobalava ZD, Konradi AO, Nedogoda S, et al. Arterial hypertension in adults. Clinical guidelines 2020. Russian Journal of Cardiology. 2020;25(3):3786. (In Russ.) doi:10.15829/1560-4071-2020-3-3786.

10. Johri AM, Nambi V, Naqvi TZ, et al. Recommendations for the Assessment of Carotid Arterial Plaque by Ultrasound for the Characterization of Atherosclerosis and Evaluation of Cardiovascular Risk: From the American Society of Echocardiography. J Am Soc Echocardiogr. 2020;33(8):917-33. doi:10.1016/j.echo.2020.04.021.

11. Ramusino MC, Altomare D, Bacchin R, et al. Medial temporal lobe atrophy and posterior atrophy scales normative values. NeuroImage Clin. 2019;24:101936. doi:10.1016/j.nicl.2019.101936.

12. Berdalin AB, Nikogosova AK, Gubskiy IL, et al. Brain Changes in the White Matter of the Brain White Matter Changes and Cognitive Functions in Asymptomatic Patients. Bull Exp Biol Med. 2020;169(5):630-4. doi:10.1007/s10517-020-04942-2.

13. Kälsch H, Lehmann N, Moebus S, et al. Aortic Calcification Onset and Progression: Association With the Development of Coronary Atherosclerosis. J Am Heart Assoc. 2017;6(4): e005093. doi:10.1161/JAHA.116.005093.