Department of Radiology, University of Washington, Seattle, WA, USA.
Center for Kidney Disease, Second Affiliated Hospital of Nanjing Medical University, 262# Zhongshan North Road, Nanjing, Jiangsu, China.
Eur Radiol. 2021 Apr;31(4):2233-2241. doi: 10.1007/s00330-020-07218-5. Epub 2020 Sep 14.
The study aimed to analyze the association between hypertension control and subclinical cerebrovascular health using a comprehensive multimodal imaging approach.
The study included 200 hypertensive older males without previous cardiovascular diseases. Clinic blood pressure (BP) was measured using a standard approach. Cerebrovascular health was evaluated using magnetic resonance imaging in the following four aspects: Intracranial atherosclerosis as determined by vessel wall imaging; Vascular rarefaction (defined as less discernible vessels on angiography) was evaluated using a custom-developed technique. Cerebral blood flow (CBF) and white matter hyperintensity (WMH) were assessed using arterial spin-labeling imaging and fluid-attenuated inversion recovery imaging, respectively.
A total of 189 subjects had MRI scans. The mean age was 64.9 (± 7.2) years. For intracranial atherosclerosis, there was a significant association between uncontrolled hypertension and presence of intracranial plaque. When systolic and diastolic BP were analyzed separately, the association remained significant for both. For vascular rarefaction, uncontrolled hypertension was associated with less discernible vessel branches or shorter vessel length on angiography. Further analysis revealed that this is due to uncontrolled diastolic BP, but not uncontrolled systolic BP. There was an association between uncontrolled hypertension and reduced CBF, which was also mainly driven by uncontrolled diastolic BP. We also found that uncontrolled diastolic BP, but not uncontrolled systolic BP, was associated with increased WMH volume.
Uncontrolled hypertension was associated with subclinical cerebrovascular injury globally, with both small and medium-to-large arteries being affected.
• In this study, we leveraged the advantage of a series of cutting-edge MR imaging and analysis techniques and found uncontrolled hypertension is associated with subclinical globally compromised cerebrovascular health. • The detrimental consequences of uncontrolled BP affect not only the small vessels but also the medium-to-large arteries, and uncontrolled systolic and diastolic BP are both independently associated with certain types of cerebrovascular injury. • Our data suggest that cerebrovascular health is impaired globally in uncontrolled hypertension before the onset of stroke.
本研究旨在采用综合多模态成像方法分析高血压控制与亚临床脑血管健康之间的关系。
本研究纳入了 200 名无既往心血管疾病的高血压老年男性。通过标准方法测量诊所血压（BP）。使用磁共振成像（MRI）从以下四个方面评估脑血管健康：血管壁成像确定的颅内动脉粥样硬化；使用定制技术评估血管稀疏（定义为血管造影上血管难以辨认）。使用动脉自旋标记成像和液体衰减反转恢复成像分别评估脑血流（CBF）和脑白质高信号（WMH）。
共有 189 名受试者进行了 MRI 扫描。平均年龄为 64.9（±7.2）岁。对于颅内动脉粥样硬化，未控制的高血压与颅内斑块的存在之间存在显著关联。当分别分析收缩压和舒张压时，两者均存在显著关联。对于血管稀疏，未控制的高血压与血管造影上分支血管难以辨认或血管长度较短有关。进一步分析表明，这是由于未控制的舒张压，而不是未控制的收缩压所致。未控制的高血压与 CBF 降低有关，这主要也是由未控制的舒张压引起的。我们还发现，未控制的舒张压，但不是未控制的收缩压，与 WMH 体积增加有关。
未控制的高血压与亚临床脑血管损伤总体相关，小动脉和中等至大动脉均受到影响。
• 在这项研究中，我们利用一系列前沿 MRI 成像和分析技术的优势，发现未控制的高血压与亚临床的整体受损的脑血管健康有关。• 未控制的血压的有害后果不仅影响小血管，还影响中等至大动脉，未控制的收缩压和舒张压都与某些类型的脑血管损伤独立相关。• 我们的数据表明，在中风发生之前，未控制的高血压会导致整体的脑血管健康受损。
