Cerebral Microangiopathy in Treatment-Resistant Hypertension


Prof Dr Roland E. Schmieder, Nephrology and Hypertensiology, University Hospital Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany
E-mail: roland.schmieder@uk-erlangen.de


J Clin Hypertens (Greenwich). 2011;13:582–587. ©2011 Wiley Periodicals, Inc.

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.