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Updated: Dec 18, 2025
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Cerebral macro- and microcirculatory blood flow dynamics in successfully treated chronic hypertensive patients with
Martin Müller1, Mareike Österreich2, Lehel Lakatos2
1Department of Neurology, Lucerne Kantonsspital, Spitalstrasse, CH-6000, Lucerne, Switzerland. martin.mueller@luks.ch.
Insights
Lowering blood pressure in patients with chronic high blood pressure normalizes brain capillary hemodynamics. However, resistance vessel function remains impaired, indicating persistent cerebrovascular changes despite treatment.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Medical Physiology
Background:
- High blood pressure (HBP) is linked to brain pathology, but the underlying mechanisms are not fully understood.
- Cerebral perfusion dynamics at the resistance vessel and capillary levels in HBP patients require further investigation.
Purpose of the Study:
- To investigate if lowering blood pressure (BP) in chronic HBP patients normalizes cerebral perfusion dynamics.
- To assess the impact of BP reduction on resistance vessel and capillary hemodynamics in the brain.
Main Methods:
- Simultaneous recordings of middle cerebral artery blood flow velocity (CBFV), BP, and end-tidal CO2 in 67 HBP patients and 49 controls.
- Near-infrared spectroscopy (NIRS) for oxygenated (O2Hb) and deoxygenated (HHb) hemoglobin in a subset of participants.
- Assessment of dynamic cerebral autoregulation (dCA) using transfer function analysis and grading of white matter lesions by the Fazekas scale.
Main Results:
- Successfully lowered BP in HBP patients (89 ± 15 mm Hg) compared to controls (87 ± 17 mm Hg).
- Cerebrovascular resistance remained higher in HBP patients.
- BP-CBFV phase was lower and gain was higher in very low and low-frequency ranges in HBP patients, indicating disturbed resistance vessel function.
- Capillary hemodynamics (CBFV-[O2Hb], CBFV-[HHb]) were comparable between HBP patients and controls.
Conclusions:
- Successfully treated chronic high blood pressure normalizes brain capillary hemodynamics.
- Despite BP normalization, cerebrovascular resistance and dynamics at the resistance vessel level remain disturbed in HBP patients.
- These findings highlight the persistent impact of HBP on cerebral microcirculation even after treatment.
Abstract:
The mechanisms of high blood pressure (HBP) -related brain pathology progression remain relatively unclear. We investigated whether lowering BP in chronic HBP patients normalizes cerebral perfusion dynamics at resistance vessel and capillary levels. Sixty-seven patients with HBP and 49 age- and sex-matched healthy controls underwent simultaneous recordings of middle cerebral artery blood flow velocity (CBFV), BP, and end-tidal CO2 concentration. Thirty-four controls and 28 patients underwent additional near-infrared spectroscopy recordings (oxygenated [O2Hb] and deoxygenated [HHb] hemoglobin). Degree of microcirculatory white matter lesions was graded by Fazekas scale. Dynamic cerebral autoregulation (dCA) was assessed by transfer function analysis. BP was successfully lowered (patients = 89 ± 15 mm Hg, controls = 87 ± 17), but cerebrovascular resistance was higher in BP patients (p < 0.05). BP-CBFV phase was lower in very low frequency (VLF) (left/right: 48 ± 20°/44 ± 17; controls: 61 ± 20/60 ± 21; p < 0.001) and low frequency (LF) (34 ± 14/35 ± 14; controls: 48 ± 20/44 ± 17; p < 0.05) ranges. Gain was higher in VLF range (in %/ mm Hg 0.56 ± 0.44/0.59 ± 0.49; controls: 0.32 ± 0.29/0.34 ± 0.32; p ≤ 0.005). BP-CBFV phase and gain did not differ across Fazekas groups. Across all patients, the capillary phases and gains (CBFV-[O2Hb], CBFV-[HHb]) were comparable to controls. Successfully treated chronic HBP results in normal brain capillary hemodynamics while the resistance vessel state is disturbed (phase decrease, gain increase).
