Brain Microcirculation and Silent Cerebral Damage
Besides age, hypertension is the cardiovascular risk factor most closely related to cerebrovascular disease. Hypertension seems to predispose to the development of cognitive impairment, dementia, and ischemic and hemorrhagic stroke after a period of time that may vary from a few years to several decades. During this time, during which the majority of hypertensives remain asymptomatic, elevated blood pressure predisposes to the development of subtle alterations, based on arteriolar narrowing or microvascular changes that involve chronic ischemia of the small arteries (cerebral white matter lesions, lacunar infarcts), as well as deposits of hemosiderin in perivascular spaces (cerebral microbleeds), mainly in deep perforating arteries in the brain. Despite the strong epidemiological relationship, the etiopathogenic mechanisms through which hypertension leads to cerebral pathology are diverse, complex and not completely understood.
KeywordsHypertension Cerebral small vessel disease Cerebral white matter lesions Cerebral microbleeds Lacunar infarcts Stroke Cognitive impairment
- 4.Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018;36:1953–2041.CrossRefGoogle Scholar
- 13.Bondjers G, Glukhova M, Hansson GK, Postnov YV, Reidy MA, Schwartz SM. Hypertension and atherosclerosis. Cause and effect, or two effects with one unknown cause? Circulation. 1991;84:VI-2–VI-16.Google Scholar
- 21.Manolio TA, Burke GL, O’Leary DH, Evans G, Beauchamp N, Knepper L, for the CHS Collaborative Research Group, et al. Relationships of cerebral MRI findings to ultrasonographic carotid atherosclerosis in older adults. The Cardiovascular Health Study. Arterioscler Thromb Vasc Biol. 1999;19:356–65.CrossRefGoogle Scholar
- 27.Longstreth WT, Manolio TA, Arnold A, Burke GL, Bryan N, Jungreis CA, for the Cardiovascular Health Study Collaborative Research Group, et al. Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people. The Cardiovascular Health Study. Stroke. 1996;27:1274–82.CrossRefGoogle Scholar