Neuroimaging in Hypertension: A Multifaceted Approach to Investigate the Brain

The brain is the most metabolically demanding organ, whose integrity and homeostasis are highly sensitive to changes in blood perfusion. Cerebrovascular alterations are therefore major drivers in the development of neurodegenerative diseases and cognitive impairment. Among cardiovascular conditions, hypertension is associated with a wide spectrum of structural and functional brain changes, being a major risk factor for dementia. The multitude of cerebrovascular alterations and consequent injuries linked to hypertension covers distinct, yet interdependent, brain aspects, from modifications in vascular morphology and hemodynamics to features of white matter or cortical damage, eventually leading to disruption of brain activity and cognitive decline. Neuroimaging approaches probe structural properties of brain tissue and vasculature, as well as cerebral perfusion and function, enabling the investigation of hypertension-induced alterations in a minimally invasive manner. In this review, we navigate through neuroimaging techniques that have been employed to study the impact of hypertension on the brain. Particularly, we highlight how these modalities can provide a multifaceted characterization of cerebral injury in hypertension, thus clarifying its relationship with structural, functional, and homeostatic brain properties.