WJCD  Vol.4 No.4 , April 2014
Resistive Cerebral Blood Flow as a Potential Marker of Subclinical Brain Damage in Essential Hypertension
ABSTRACT
Introduction: Subclinical brain damage in essential hypertension is more prevalent than cardiovascular or renal impairment; nevertheless, screening for nervous system involvement is difficult due to the low accessibility and high costs of these techniques. Objective: To assess the frequency of silent target organ damage in a cohort of asymptomatic hypertensive patients and to evaluate the potential usefulness of carotid ultrasonographic (US) variables as predictors of subclinical brain damage. Patients and Methods: Thirty four neurologically asymptomatic subjects (mean age 59 years) with essential hypertension were included. Target organ damage was evaluated: degree of hypertensive retinopathy, heart, kidney and brain. Structural and hemodynamical carotid Doppler US parameters were also investigated. Results: The brain was the most frequently affected target organ (70.6%), followed by the heart (67.9%) and kidney (58.6%). Carotid US parameters showed no association of intima media thickness with brain MRI results; nevertheless, decreased diastolic flow velocity and increased resistive index pointed to a resistive carotid flow pattern in patients with classical brain MRI lesions and predicted subclinical lesions with a sensitivity of 70% and 74% and a specificity of 72% and 80% respectively. Conclusions: This study supports previous findings that place the brain as the most frequently affected target organ in essential hypertensive patients and sheds more light on the potential usefulness of carotid structure and hemodynamics as imaging biomarkers of subclinical brain lesions.

Cite this paper
González-García, S. , Hernández-Díaz, Z. , Quevedo-Sotolongo, L. , Peña-Sánchez, M. , Pino-Peña, Y. , Fernández-Carriera, R. , Menéndez-Saínz, C. , González-Quevedo, A. and Eells, J. (2014) Resistive Cerebral Blood Flow as a Potential Marker of Subclinical Brain Damage in Essential Hypertension. World Journal of Cardiovascular Diseases, 4, 169-178. doi: 10.4236/wjcd.2014.44025.
References
[1]   Pérez, C.M.D., Dueñas, H.A., Alfonso, G.J.P., et al. (2006) Guidelines for the Treatment, Prevention and Diagnosis of Arterial Hypertension. Editorial Ciencias Médicas, La Habana.
http://www.bvs.sld.cu/libros_texto/hipertension_arterial/indice_p.htm

[2]   Mancia, G., Fagard, R., Narkiewicz, K., Redon, J., Zanchetti, A., Böhm, M., et al. (2013) 2013 ESH/ESC Practice Guidelines for the Management of Arterial Hypertension. Blood Pressure, 23, 3-16.

[3]   Shlomai, G., Grassi, G., Grossman, E. and Mancia, G. (2013) Assessment of Target Organ Damage in the Evaluation and Follow-Up of Hypertensive Patients: Where Do We Stand? The Journal of Clinical Hypertension, 15, 742-747.

[4]   Al-Sarraf, H. and Philip, L. (2003) Effect of Hypertension on the Integrity of Blood Brain and Blood CSF Barriers, Cerebral Blood Flow and CSF Secretion in the Rat. Brain Research, 975, 179-188.
http://dx.doi.org/10.1016/S0006-8993(03)02632-5

[5]   Amenta, F., Di Tullio, M.A. and Tomassoni, D. (2003) Arterial Hypertension and Brain Damage—Evidence from Animal Models (Review). Clinical and Experimental Hypertension, 25, 359-380.
http://dx.doi.org/10.1081/CEH-120023545

[6]   Henskens, L.H., van Oostenbrugge, R.J., Kroon, A.A., Hofman, P.A., Lodder, J. and de Leeuw, P.W. (2009) Detection of Silent Cerebrovascular Disease Refines Risk Stratification of Hypertensive Patients. Journal of Hypertension, 27, 846-853.
http://dx.doi.org/10.1097/HJH.0b013e3283232c96

[7]   Vermeer, S.E., Longstreth, W.T. and Koudstaal, P.J. (2007) Silent Brain Infarcts: A Systematic Review. The Lancet Neurology, 6, 611-619.
http://dx.doi.org/10.1016/S1474-4422(07)70170-9

[8]   Feihl, F., Liaudet, L. and Waeber, B. (2009) The Macrocirculation and Microcirculation of Hypertension. Current Hypertension Reports, 11, 182-189.
http://dx.doi.org/10.1007/s11906-009-0033-6

[9]   Kearney-Schwartz, A., Rossignol, P., Bracard, S., et al. (2009) Vascular Structure and Function Is Correlated to Cognitive Performance and White Matter Hyperintensities in Older Hypertensive Patients with Subjective Memory Complaints. Stroke, 40, 1229-1236.
http://dx.doi.org/10.1161/STROKEAHA.108.532853

[10]   Shenkin, S.D., Bastin, M.E., MacGillivray, T.J., et al. (2010) Carotid Intima-Media Thickness and Cerebrovascular Disease in Community-Dwelling Older People without Stroke. Stroke, 41, 2083-2086.
http://dx.doi.org/10.1161/STROKEAHA.110.590505

[11]   Kidwell, C.S., El-Saden, S., Livshits, Z., Martin, N.A., Glenn, T.C. and Saver, J.L. (2001) Transcranial Doppler Pulsatility Indices as a Measure of Diffuse Small-Vessel Disease. Journal of Neuroimaging, 11, 229-235.
http://dx.doi.org/10.1111/j.1552-6569.2001.tb00039.x

[12]   Kurata, M., Okura, T., Watanabe, S. and Higaki, J. (2005) Association between Carotid Hemodynamics and Asymptomatic White and Gray Matter Lesions in Patients with Essential Hypertension. Hypertension Research, 28, 797-803.
http://dx.doi.org/10.1291/hypres.28.797

[13]   Chobanian, A.V., Bakris, G.L., Black, H.R., Cushman, W.C., Green, L.A., Izzo Jr., J.L., et al. (2003) The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. Journal of the American Medical Association, 289, 2560-2571.
http://dx.doi.org/10.1001/jama.289.19.2560

[14]   Scheie, H.G. (1953) Evaluation of Ophthalmoscopic Changes of Hypertension and Arteriolar Sclerosis. AMA Archives of Ophthalmology, 49, 117-138.
http://dx.doi.org/10.1001/archopht.1953.00920020122001

[15]   Cockroft, D.W. and Gault, M.H. (1976) Prediction of Creatinine Clearance from Serum Creatinine. Nephron, 16, 31-41.
http://dx.doi.org/10.1159/000180580

[16]   González-Quevedo, A., García, S.G., Concepción, O.F., Freixas, R.S., Sotolongo, L.Q., Menéndez, M.C., et al. (2011) Increased Serum S-100B and Neuron Specific Enolase—Potential Markers of Early Nervous System Involvement in Essential Hypertension. Clinical Biochemistry, 11, 154-159.
http://dx.doi.org/10.1016/j.clinbiochem.2010.11.006

[17]   Henskens, L.H., van Oostenbrugge, R.J., Kroon, A.A., Hofman, P.A., Lodder, J. and de Leeuw, P.W. (2009) Detection of Silent Cerebrovascular Disease Refines Risk Stratification of Hypertensive Patients. Journal of Hypertension, 27, 846-853.
http://dx.doi.org/10.1097/HJH.0b013e3283232c96

[18]   Hernández-González, G., Bringas-Vega, M.L., Galán-García, L., Bosch-Bayard, J., et al. (2011) Multimodal Quantitative Neuroimaging Databases and Methods: The Cuban Brain Mapping Project. Clinical EEG and Neuroscience, 42, 1-12.
http://dx.doi.org/10.1177/155005941104200303

[19]   Mancia, G., Laurent, S., Agabiti-Rosei, E., Ambrosioni, E., Burnier, M., Caulfield, M.J., et al. (2009) Reappraisal of European Guidelines on Hypertension Management: A European Society of Hypertension Task Force document. Blood Pressure, 18, 308-347.
http://dx.doi.org/10.3109/08037050903450468

[20]   Pantoni, L. (2010) Cerebral Small Vessel Disease: From Pathogenesis and Clinical Characteristics to Therapeutic Challenges. The Lancet Neurology, 9, 689-701.
http://dx.doi.org/10.1016/S1474-4422(10)70104-6

[21]   Liao, D., Cooper, L., Cai, J., Toole, J.F., Bryan, N., Hutchinson, R.G., et al. (1996) Presence and Severity of Cerebral White Matter Lesions and Hypertension, Its Treatment, and Its Control. The ARIC Study. Stroke, 27, 2262-2270.
http://dx.doi.org/10.1161/01.STR.27.12.2262

[22]   Longstreth, W.T., Manolio, T.A., Arnold, A., Burke, G.L., Bryan, N., Jungreis, A., et al. (1996) For the Cardiovascular Health Study Collaborative Research Group. Clinical Correlates of White Matter Findings on Cranial Magnetic Resonance Imaging of 3301 Elderly People. The Cardiovascular Health Study. Stroke, 27, 1274-1282.
http://dx.doi.org/10.1161/01.STR.27.8.1274

[23]   Van Boxtel, M., Henskens, L., Kroon, A., Hofman, P., Gronenschild, E., Jolles, J., et al. (2006) Ambulatory Blood Pressure, Asymptomatic Cerebrovascular Damage and Cognitive Function in Essential Hypertension. Journal of Human Hypertension, 20, 5-13.
http://dx.doi.org/10.1038/sj.jhh.1001934

[24]   Scuteri, A., Nilssonb, P., Tzourioc, C., Redond, J. and Laurente, S. (2011) Microvascular Brain Damage with Aging and Hypertension: Pathophysiological Consideration and Clinical Implications. Journal of Hypertension, 29, 1469-1477.
http://dx.doi.org/10.1097/HJH.0b013e328347cc17

[25]   Henskens, L.H., Kroon, A.A., van Oostenbrugge, R.J., Gronenschild, E.H., Hofman, P.A., Lodder, J., et al. (2009) Associations of Ambulatory Blood Pressure Levels with White Matter Hyperintensity Volumen in Hypertensive Patients. Journal of Hypertension, 27, 1446-1452.
http://dx.doi.org/10.1097/HJH.0b013e32832b5204

[26]   Kurata, M., Okura, T., Watanabe, S. and Higaki, J. (2005) Association between Carotid Hemodynamics and Asymptomatic White and Gray Matter Lesions in Patients with Essential Hypertension. Hypertension Research, 28, 797-803.
http://dx.doi.org/10.1291/hypres.28.797

[27]   Heliopoulos, I., Artemis, D., Vadikolias, K., Tripsianis, G., Piperidou, C. and Tsivgoulis, G. (2012) Association of Ultrasonographic Parameters with Subclinical White-Matter Hyperintensities in Hypertensive Patients. Cardiovascular Psychiatry and Neurology, 2012, Article ID: 616572.
http://dx.doi.org/10.1155/2012/616572

 
 
Top