Cerebral microangiopathy in treatment-resistant hypertension

Cerebral microangiopathy is a cause of cognitive impairment and indicates high risk for clinically overt cerebrovascular disease. It develops in patients with or without hypertension, and different pathologies may play a supporting role. In this pilot study, the authors aimed to elucidate risk factors contributing to the deleterious action of hypertension on cerebral small vessels. A cross-sectional study in 42 patients with treatment-resistant hypertension was performed. Microangiopathy was investigated by cerebral magnetic resonance imaging (MRI). Determinants were identified by clinical investigation, computed tomography, intima-media thickness and pulse wave velocity measurement, and urinary albumin excretion. Nineteen of 42 patients had cerebral microangiopathy (23 controls). Patients were different with respect to heart rate (60.5 ± 10.2 vs 69.7 ± 15.1 beats per minute; P = .029) and systolic blood pressure during nighttime (138 ± 13 mm Hg vs 126 ± 18 mm Hg; P = .019). In addition, there were significant differences in pulse wave velocity (10.7 ± 2.0 m/s vs 9.4 ± 1.4 m/s; P = .034), peripheral pulse pressure (70.8 ± 16.3 mm Hg vs 59.2 ± 13.6 mm Hg; P = .016), central pulse pressure (62.9 ± 15.8 mm Hg vs 50.3 ± 14.2 mm Hg; P = .012), and aortic augmentation pressure (15.9 ± 6.0 vs 11.8 ± 6.6; P = .040). Systolic blood pressure and signs of hypertensive vasculopathy such as peripheral and central pulse pressure and pulse wave velocity were associated with cerebral microangiopathy in patients with long-standing treatment-resistant hypertension.