[Hypertension]

Area of Science:

• Neurology
• Cardiology
• Radiology

Background:

• Hypertension is a primary risk factor for stroke.
• Current guidelines recommend a target blood pressure of 130/80 mmHg for stroke prevention.
• Cerebral small-vessel disease is increasingly recognized as a contributor to stroke risk.

Purpose of the Study:

• To evaluate the benefit of intensive blood pressure lowering (<120/80 mmHg) for stroke prevention.
• To assess the utility of brain MRI in stratifying stroke risk based on cerebral small-vessel disease.
• To determine the association between small vessel disease burden and incident stroke risk.

Main Methods:

• Review of current hypertension and stroke prevention guidelines.
• Analysis of brain MRI findings (white matter hyperintensities, lacunar infarctions, cerebral microbleeds, enlarged perivascular spaces) indicative of small vessel disease.
• Development and application of a total small-vessel disease score (0-4) for risk stratification.

Main Results:

• Intensive blood pressure lowering (<120/80 mmHg) is beneficial for preventing intracerebral hemorrhage, particularly in high-risk patients.
• Brain MRI evaluation of small vessel disease aids in risk stratification for incident stroke in individuals without a prior stroke history.
• Presence of any small vessel disease on MRI is associated with an increased risk of incident stroke.

Conclusions:

• Lowering blood pressure below 120/80 mmHg is recommended for high-risk individuals to prevent hemorrhagic stroke.
• Brain MRI is a valuable tool for identifying cerebral small-vessel disease and stratifying stroke risk.
• Intensive blood pressure management is crucial for all individuals with evidence of small vessel disease to reduce overall stroke risk.