Objective: analysis of MRI changes in patients with arterial hypertension at degree 1 and 2.
Methods: there were enrolled 98 patients (aged from 50 to 65 years old, mean age 57+/- 6 years old) with “uncomplicated” arterial hypertension (HTN), who did not have any occlusive large vessel disease, any cardiac disease, and traumatic brain injury, and were otherwise healthy.
MRI imaging was done on Magnetom Symphony scan 1.5 Tesla (Siemens) with a slice thickness of 0.5 cm and T1 and T2, T2d-f fluid attenuated inversion recovery (FLAIR) scans were reviewed. Blood pressure (BP) monitoring was done by MDP NS 02 system that is based on oscillometric method of blood pressure measurement. The measurements were taken over 24 hours with 15-minute intervals at the daytime and 30-minute intervals during the nighttime.
Calculated average duration of HTN was 12+/- 9 years, and BP measurements were in keeping with HTN at degree 1and 2 (140-180/90-110 mmHg). There were no vascular lesions on MRI noted in 25/89 patients (30%). Multifocal scattered hyperintense signal changes in subcortical and periventricular white matter on T2 and T2-FLAIR were noted in 60/89 patients (69%). Among them focal changes no more than 5 were noticed in 35/60 patients (58%), multiple foci were seen in 25/60 patients (42%). Widened perivascular spaces were seen in 54/89 patients (61%). Asymptomatic lacunar infarcts were seen in 6/89 patients (7%), leukoaraiosis changes were noticed in 6/89 patients (7%) with a predominant localization in periventricular regions of anterior horns of lateral ventricles. Widening of subarachnoid spaces was found in 17/89 patients (19%), ventricular dilatation was seen in 20/89 patients (22%). There was a moderate reliable correlation (Kendall rank correlation coefficient) seen between MRI changes and BP measurements:
- Widening of perivascular spaces correlated with increased variability of systolic BP at daytime and nighttime (r=0.25; p=0.0009);
- Widening of subarachnoid spaces and systolic BP (r=0.2; p=0.005), and pulse pressure (r=0.26; p=0.0004);
- Asymptomatic or “silent” lacunar infarcts and degree of arterial hypertension (r=0.22; p=0.002);
- T2 and T2-FLAIR white matter hyperintensities and duration of HTN (r=0.13; p=0.06),
- Widening of perivascular spaces and age (r=0.16; p=0.025), duration of HTN (r=0.17; p=0.01); pulse pressure (r=0.16; p=0.03);
- Widening of subarachnoid spaces and duration of HTN (r=0.19; p=0.01), degree of HTN (r=0.17; p=0.02).
- Asymptomatic lacunar infarcts and hypertensive emergency (r=0.17; p=0.018); degree of HTN (r=0.22, p=0.002), degree of nighttime lowering of BP (r=-0.2; p=0.006), increased daytime variability of systolic BP (r=0.17, p=0.01).
Conclusions: Diffuse and focal brain changes, widening of perivascular spaces in patients with arterial hypertension are usually viewed as accidental findings; however, they result from a direct deleterious effect of arterial hypertension. These changes are supportive to the opinion that patients with arterial hypertension should be classified as a high-risk group for cardiovascular diseases.
O.Andreeva, A.Amintaeva, M.Prokopovich, Y.Varakin, G.Gornostaeva
Posted by: Oksana Andreeva, neurologist, CS of Neurology, Russian Federation (30-Oct-2012)