Daily profile of arterial pressure and brain microstructural changes in patients with hypertension-related cerebral small vessel disease

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Abstract

Introduction. Application of modern antihypertensive medications has improved the course of arterial hypertension (AH), but has not led to the expected decrease
in small vessel disease (SVD) incidence and its complications. This fact encourages further investigation of hypertension-related mechanisms of brain damage.
Objective: to study the relation between daily profile of blood pressure and brain microstructure changes in patients with both SVD and AH.
Material and methods. The study included 64 patients (38 – 59.4%) female, mean age 59.4±5.4 years) with both SVD and AH. Ambulatory blood pressure
monitoring and diffusion-tensor MRI were obtained for all participants. The relation between studied parameters was estimated using the multivariate statistical
analysis method – linear regression analysis.
Results. Сhanges in daily profile of blood pressure according to ambulatory blood pressure monitoring data was associated with microstructure abnormalities of
the juxtacortical white matter hyperintensities (jWMH) of anterior frontal lobes, temporal-parietal regions and left posterior cingulate cortex. An increase and
variability of diastolic blood pressure were of primary importance in brain microstructural damage in mentioned areas leading to mean diffusivity and radial
diffusivity increase.
Conclusion. The revealed relation between daily profile of blood pressure and brain microstructural changes indicating increase of free water diffusivity and
myelin damage in jWMH and posterior cingulate cortex corresponds to the experimental data on the breakdown of the autoregulation reaction in cortex arteries
and further increase of brain-blood barrier permeability with descending vasogenic edema in brain damage in hypertensive patients. An increase and variability of
diastolic blood pressure have primary importance to microstructural damage of white matter in patients with SVD receiving antihypertensive treatment.

About the authors

Larisa A. Dobrynina

Research Center of Neurology

Author for correspondence.
Email: dobrla@mail.ru
ORCID iD: 0000-0001-9929-2725

D. Sci. (Med.), Head, 3rd Neurology department

Russian Federation, Moscow

Kamila V. Shamtieva

Research Center of Neurology

Email: dobrla@mail.ru
Russian Federation, Moscow

Еlena I. Kremneva

Research Center of Neurology

Email: dobrla@mail.ru
Russian Federation, Moscow

Lyudmila A. Kalashnikova

Research Center of Neurology

Email: dobrla@mail.ru
Russian Federation, Moscow

Marina V. Krotenkova

Research Center of Neurology

Email: dobrla@mail.ru
ORCID iD: 0000-0003-3820-4554

D. Sci. (Med.), Head, Neuroradiology department

Russian Federation, 125367 Moscow, Volokolamskoye shosse, 80

Elena V. Gnedovskaya

Research Center of Neurology

Email: dobrla@mail.ru
Russian Federation, Moscow

Aleksandr B. Berdalin

M.V. Lomonosov Moscow State University

Email: dobrla@mail.ru
Russian Federation, Moscow

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