Subclinical cerebral manifestations and changes of brain associated with newly diagnosed asymptomatic arterial hypertension

Background. Progressive aggravation of cerebral affection in patients with asymptomatic arterial hypertension (AH) suggests importance of the affection in the development of subclinical cerebral manifestations.
Objective. To evaluate the dependence of subclinical depression, anxiety, and memory impairments on the severity of white matter hyperintensity (WMH) and microstructural changes in a visually intact brain matter in patients with asymptomatic AH.
Materials and methods. The study involved 82 patients with newly diagnosed asymptomatic AH, aged 40−59 years. All patients were assessed for delayed memory (Luria’s test) as well as depression and anxiety (Hospital Anxiety and Depression Scale (HADS)) and underwent brain MRI (T1 and T2 weighted imaging, FLAIR, diffusion weighted imaging with calculation of apparent diffusion coefficient (ADC) maps).
Results. The earliest structural-functional relationships between subdepressive symptoms and ACD-assessed microstructural changes were found in the hippocampus, thalamus, and visually intact deep white matter of the cerebral hemispheres. AH worsening was accompanied by a growing number of areas associated with subclinical depression, anxiety, and memory impairments and characterized by WMH lesions and an increased ACD in a visually intact brain matter.
Conclusion. Microstructural changes in the hippocampus, thalamus, and deep structures of the hemispheres are the structural/functional basis of subclinical depression at the early AH stages. The AH worsening-associated involvement of new structures associated with subclinical depression, anxiety, and memory impairments, which are characterized by an increased ACD and WMH lesions, demonstrates the importance of progressive diffuse brain damage in the development of both subclinical and subsequent clinical manifestations of depression, anxiety, and memory impairments.The nature of relationships between hypertension and depression needs to be clarified. In this connection, it seems appropriate to study the role of their common stress-induced processes: inflammation and neurovascular association due to hyperactivation of the suprasegmental autonomic centers.