[Current state of cerebral microangiopathy in hypertension]

Area of Science:

• Neurology
• Vascular Medicine
• Pathology

Background:

• Hypertension is a primary risk factor for cerebrovascular diseases, including acute stroke and chronic insufficiency.
• Hypertension-induced cerebral microangiopathy underlies small deep infarcts (SDIs) and diffuse white matter diseases, contributing to neurological and mental disorders.
• These vascular changes can progress to dementia and predict severe outcomes like cerebral hemorrhages.

Purpose of the Study:

• To review the morphology, pathogenesis, and diagnosis of hypertensive small deep infarcts (SDIs).
• To differentiate hypertensive SDIs from atherosclerotic SDIs.
• To explore current research on diffuse white matter changes and the role of blood-brain barrier dysfunction in hypertensive leukoencephalopathy.

Main Methods:

• Literature review focusing on morphology, pathogenesis, clinical, and neuroimaging aspects.
• Historical analysis of diagnostic approaches.
• Examination of current research on white matter changes and blood-brain barrier integrity.

Main Results:

• Hypertension is linked to specific pathologies of intracerebral arteries and microvasculature, causing SDIs and white matter disease.
• Hypertensive SDIs have distinct features and diagnostic considerations compared to atherosclerotic SDIs.
• The lacunar state of the brain in hypertension predicts future cerebral hemorrhages.
• Progressive leukoencephalopathy is associated with diffuse white matter changes and impaired blood-brain barrier function.

Conclusions:

• Hypertension significantly impacts cerebral vasculature, leading to diverse pathologies and clinical manifestations.
• Accurate diagnosis and differentiation of hypertensive cerebrovascular changes are essential for patient management.
• Further research into white matter disease pathogenesis and blood-brain barrier integrity is vital for understanding and treating hypertensive encephalopathy.