Janssen Esther, Ter Telgte Annemieke, Verburgt Esmée, de Jong Joost Ja, Marques José P, Kessels Roy Pc, Backes Walter H, Maas Marnix C, Meijer Frederick Ja, Deinum Jaap, Riksen Niels P, Tuladhar Anil M, de Leeuw Frank-Erik
Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands.
Eur Stroke J. 2022 Sep;7(3):331-338. doi: 10.1177/23969873221100331. Epub 2022 May 12.
Neuroimaging markers of cerebral small vessel disease (SVD) are common in older individuals, but the pathophysiological mechanisms causing these lesions remain poorly understood. Although hypertension is a major risk factor for SVD, the direct causal effects of increased blood pressure are unknown. The Hyperintense study is designed to examine cerebrovascular and structural abnormalities, possibly preceding SVD, in young adults with hypertension. These patients undergo a diagnostic work-up that requires patients to temporarily discontinue their antihypertensive agents, often leading to an increase in blood pressure followed by a decrease once effective medication is restarted. This allows examination of the effects of blood pressure increase and decrease on the cerebral small vessels.
Hyperintense is a prospective observational cohort study in 50 hypertensive adults (18-55 years) who will temporarily discontinue antihypertensive medication for diagnostic purposes. MRI and clinical data is collected at four timepoints: before medication withdrawal (baseline), once antihypertensives are largely or completely withdrawn ( = 1), when patients have restarted medication ( = 2) and reached target blood pressure and 1 year later ( = 3). The 3T MRI protocol includes conventional structural sequences and advanced techniques to assess various aspects of microvascular integrity, including blood-brain barrier function using Dynamic Contrast Enhanced MRI, white matter integrity, and microperfusion. Clinical assessments include motor and cognitive examinations and blood sampling.
The Hyperintense study will improve the understanding of the pathophysiological mechanisms following hypertension that may cause SVD. This knowledge can ultimately help to identify new targets for treatment of SVD, aimed at prevention or limiting disease progression.
脑小血管病（SVD）的神经影像学标志物在老年人中很常见，但导致这些病变的病理生理机制仍知之甚少。虽然高血压是SVD的主要危险因素，但血压升高的直接因果效应尚不清楚。高强度研究旨在检查高血压青年成人中可能先于SVD出现的脑血管和结构异常。这些患者要接受诊断检查，这需要患者暂时停用抗高血压药物，这通常会导致血压升高，而一旦重新开始使用有效药物，血压又会下降。这使得能够研究血压升降对脑小血管的影响。
高强度研究是一项前瞻性观察队列研究，对50名年龄在18至55岁之间的高血压成人进行，他们将为诊断目的暂时停用抗高血压药物。在四个时间点收集MRI和临床数据：停药前（基线）、抗高血压药物基本或完全停用后（=1）、患者重新开始用药并达到目标血压时（=2）以及1年后（=3）。3T MRI方案包括传统结构序列和先进技术，以评估微血管完整性的各个方面，包括使用动态对比增强MRI评估血脑屏障功能、白质完整性和微灌注。临床评估包括运动和认知检查以及血液采样。
高强度研究将增进对高血压后可能导致SVD的病理生理机制的理解。这些知识最终有助于确定SVD治疗的新靶点，旨在预防或限制疾病进展。
