Cerebral microangiopathy in treatment-resistant hypertension

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.