Brain MRI: a useful tool for screening of hypertensive patients for silent cerebro-vascular damage

Meena K. Rana, Manish K. Thakur, Dhruv Gupta


Background: Worldwide hypertension is an important public-health challenge because of its high frequency and concomitant risks of cardiovascular, renal, cerebrovascular disease and death. Current guidelines for the management of hypertension mainly recommend the search for preclinical damage to the heart and kidneys. However, extending this search to other organs, for instance the brain, might improve risk stratification, might optimize antihypertensive therapy and might, in the end help to further reduce the burden of disease attributable to hypertension.

Methods: 84 consecutive hypertensive patients with no target organ damage were enrolled in study to find out silent brain damage over a period of one year.

Results: Mean body mass index (BMI) of the study population was 28.4±2.5 kg/m2 (range 23.2 to 35.3kg/m2). 33 (39.3%) subjects had white matter lesions. 13 (15.47%) study subjects were found to have vascular changes which included micro angiopathic changes, infarcts and reduced/slow blood flow. 33 (39.3%) subjects were found to have normal brain MRI in the study. Early brain MRI was found to be beneficial in patients who had uncontrolled blood pressure either due to lack of treatment or irregular use of anti-hypertensive treatment. This was true for every age group in general and particularly in subjects above the age of 50 years.

Conclusions: The screening of hypertensive patients for silent cerebrovascular damage with brain MRI may be useful in stratifying the risk of future cerebrovascular disease.


Brain, End organ damage, Hypertension, MRI

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Whitworth JA. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens. 2003;21:1983-92.

Lawes CM, Vander Hoorn S, Law MR, Elliott P, MacMahon S, Rodgers A. Blood pressure and the global burden of disease 2000. Part II: Estimates of attributable burden. J Hypertens. 2006;24:423-30.

Staessen JA, Wang J, Bianchi G, Birkenhager WH. Essential hypertension. Lancet. 2003;361:1629-41.

Mensah GA, Croft JB, Giles WH. The heart, kidney, and brain as target organs in hypertension. Cardiol Clin. 2002;20:225-47.

Persu A, De Plaen JF. Recent insights in the development of organ damage caused by hypertension. Acta Cardiol. 2004;59:369-81.

Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 guidelines for the management of arterial hypertension: The task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007;25:1105-87.

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. The seventh report of the joint national committee onprevention, detection, evaluation, and treatment of high blood pressure: The JNC 7 report. JAMA. 2003;289:2560-72.

Rosa TT, Palatini P. Clinical value of microalbuminuria in hypertension. J Hypertens. 2000;18:645-54.

Vakili BA, Okin PM, Devereux RB. Prognostic implications of left ventricular hypertrophy. Am Heart J. 2001;141:334-41.

Feigin VL, Lawes CM, Bennett DA, Anderson CS. Stroke epidemiology: A review of population based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol. 2003;2:43-53.

Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: Analysis of worldwide data. Lancet. 2005;365:217-23.

Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. MR signal abnormalities at 1.5 T in alzheimer's dementia and normal aging. Am J Roentgenol. 1987;149:351-6.

Roob G, Fazekas F. Magnetic resonance imaging of cerebral microbleeds. Curr Opin Neurol. 2000;13:69-73.

Bernick C, Kuller L, Dulberg C, Longstreth WT, Jr. Manolio T, Beauchamp N, et al. Silent MRI infarcts and the risk of future stroke: The Cardiovascular Health Study. Neurology. 2001;57:1222-9.

Kuller LH, Longstreth WT, Arnold AM, Bernick C, Bryan RN, Beauchamp NJ. White matter hyperintensity on cranial magnetic resonance imaging: a predictor of stroke. Stroke. 2004;35(8):1821-5.

Vermeer SE, Hollander M, van Dijk EJ, Hofman A, Koudstaal PJ, Breteler MM. Silent brain infarcts and white matter lesions increase stroke risk in the general population: The Rotterdam Scan Study. Stroke. 2003;34:1126-9.

Lammie GA. Hypertensive cerebral small vessel disease and stroke. Brain Pathol. 2002;12:358-70.

Paulson OB, Waldemar G, Schmidt JF, Strandgaard S. Cerebral circulation under normal and pathologic conditions. Am J Cardiol. 1989;63:2C-5C.

Sierra C. Cerebral white matter lesions in essential hypertension. Curr Hypertens Rep. 2001;3:429-33.

Vermeer SE, Longstreth WT, Jr. Koudstaal PJ. Silent brain infarcts: A systematic review. Lancet Neurol. 2007;6:611-9.

Cordonnier C, Al-Shahi Salman R, Wardlaw J. Spontaneous brain microbleeds: Systematic review, subgroup analyses and standards for study design and reporting. Brain. 2007;130:1988-2003.

Raz N, Rodrigue KM, Kennedy KM, Acker JD. Vascular healthand longitudinal changes in brain and cognition in middle-agedand older adults. Neuropsychology. 2007;21:149-157.

Gianaros PJ, Greer PJ, Ryan CM, Jennings JR. Higher bloodpressure predicts lower regional grey matter volume: consequences on short-term information processing. Neuroimage. 2006;31:754-65.

Maillard P, Seshadri S, Beiser A, Himali JJ, Au R, Fletcher E, et al. Effects of systolic blood pressure on white-matter integrity in young adults in the Framingham Heart Study: a cross-sectional study. The Lancet Neurology. 2012;11(12):1039-47.

DeCarli C, Murphy DG, Tranh M, Grady CL, Haxby JV, Gillette JA, et al. The effect of white matter hyperintensity volume on brain structure, cognitive performance, and cerebral metabolism of glucose in 51 healthy adults. Neurology. 1995;45(11):2077-84.

Debette S, Seshadri S, Beiser A, Au R, Himali JJ, Palumbo C, et al. Midlife vascular risk factor exposure accelerates structural brain aging and cognitive decline. Neurology. 2011;77(5):461-8.

Vlek AL, Visseren FL, Kappelle LJ, Witkamp TD, Vincken KL, et al. Blood pressure and white matter lesions in patients with vascular disease: the SMART-MR study. Current neurovascular research. 2009;6(3):155-62.

Liao D, Cooper L, Cai J, Toole JF, Bryan NR, Hutchinson RG, et al. Presence and severity of cerebral white matter lesions and hypertension, its treatment, and its control: The ARIC Study. Stroke. 1996;27(12):2262-70.

Mäntylä R, Erkinjuntti T, Salonen O, Aronen HJ, Peltonen T, Pohjasvaara T, et al. Variable agreement between visual rating scales for white matter hyperintensities on MRI: comparison of 13 rating scales in a poststroke cohort. Stroke. 1997;28(8):1614-23.

Krishnan MS, O'Brien JT, Firbank MJ, Pantoni L, Carlucci G, Erkinjuntti T, et al. Relationship between periventricular and deep white matter lesions and depressive symptoms in older people- The LADIS study. Int J Geriatr Psychiatry. 2006;21:983-9.

Prins ND, van Dijk EJ, den Heijer T, Vermeer SE, Jolles J, Koudstaal PJ, et al. Cerebral small-vesseldisease and decline in information processing speed, executivefunction and memory. Brain. 2005;128:2034-41.

Manolio TA, Olson J, Longstreth WT. Hypertension andcognitive function: Pathophysiologic effects of hypertension on the brain. Curr Hypertens Rep. 2003;5:255-61.

Jeerakathil T, Wolf PA, Beiser A, Massaro J, Seshadri S, D’Agostino RB, et al. Stroke risk profile predicts white matter hyperintensity volume: the Framingham Study. Stroke. 2004;35(8):1857-61.

Raz N, Rodrigue KM, Kennedy KM, Acker JD. Vascular health and longitudinal changes in brain and cognition in middle-aged and older adults. Neuropsychology. 2007;21:149-57.

Au R, Massaro JM, Wolf PA, Young ME, Beiser A, Seshadri S, et al. Association of white matter hyperintensity volume with decreased cognitive functioning: the Framingham Heart Study. Archives neurology. 2006;63(2):246-50.

Seshadri S, Wolf PA, Beiser A, Vasan RS, Wilson PW, Kase CS, et al. Elevated midlife blood pressure increases stroke risk in elderly persons: the Framingham Study. Archives of internal medicine. 2001;161(19):2343-50.