title: Cerebral microangiopathy in treatment-resistant hypertension.
abstract: 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.
authors.affiliation: Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany. roland.schmieder@uk-erlangen.de
authors.forename: Roland E
authors.initials: RE
authors.lastname: Schmieder
authors.forename: Bernhard M W
authors.initials: BM
authors.lastname: Schmidt
authors.forename: Ulrike
authors.initials: U
authors.lastname: Raff
authors.forename: Peter
authors.initials: P
authors.lastname: Bramlage
authors.forename: Arnd
authors.initials: A
authors.lastname: Dörfler
authors.forename: Stephan
authors.initials: S
authors.lastname: Achenbach
authors.forename: Johannes
authors.initials: J
authors.lastname: Schwab
authors.forename: Peter
authors.initials: P
authors.lastname: Kolominsky-Rabas
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D016022:Case-Control Studies; D059345:Cerebral Small Vessel Diseases / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology*; D017023:Coronary Angiography; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012307:Risk Factors; D017539:Tunica Intima / Q000000981:diagnostic imaging; D017540:Tunica Media / Q000000981:diagnostic imaging; D014463:Ultrasonography
chemical_list: D000959:Antihypertensive Agents