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Uncontrolled hypertension associates with subclinical cerebrovascular health globally: a multimodal imaging study

  • Magnetic Resonance
  • Published:
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Abstract

Objectives

The study aimed to analyze the association between hypertension control and subclinical cerebrovascular health using a comprehensive multimodal imaging approach.

Methods

The study included 200 hypertensive older males without previous cardiovascular diseases. Clinic blood pressure (BP) was measured using a standard approach. Cerebrovascular health was evaluated using magnetic resonance imaging in the following four aspects: Intracranial atherosclerosis as determined by vessel wall imaging; Vascular rarefaction (defined as less discernible vessels on angiography) was evaluated using a custom-developed technique. Cerebral blood flow (CBF) and white matter hyperintensity (WMH) were assessed using arterial spin-labeling imaging and fluid-attenuated inversion recovery imaging, respectively.

Results

A total of 189 subjects had MRI scans. The mean age was 64.9 (± 7.2) years. For intracranial atherosclerosis, there was a significant association between uncontrolled hypertension and presence of intracranial plaque. When systolic and diastolic BP were analyzed separately, the association remained significant for both. For vascular rarefaction, uncontrolled hypertension was associated with less discernible vessel branches or shorter vessel length on angiography. Further analysis revealed that this is due to uncontrolled diastolic BP, but not uncontrolled systolic BP. There was an association between uncontrolled hypertension and reduced CBF, which was also mainly driven by uncontrolled diastolic BP. We also found that uncontrolled diastolic BP, but not uncontrolled systolic BP, was associated with increased WMH volume.

Conclusions

Uncontrolled hypertension was associated with subclinical cerebrovascular injury globally, with both small and medium-to-large arteries being affected.

Key Points

• In this study, we leveraged the advantage of a series of cutting-edge MR imaging and analysis techniques and found uncontrolled hypertension is associated with subclinical globally compromised cerebrovascular health.

• The detrimental consequences of uncontrolled BP affect not only the small vessels but also the medium-to-large arteries, and uncontrolled systolic and diastolic BP are both independently associated with certain types of cerebrovascular injury.

• Our data suggest that cerebrovascular health is impaired globally in uncontrolled hypertension before the onset of stroke.

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Abbreviations

CBF:

Cerebral blood flow

eGFR:

Estimated glomerular filtration rate

UDBP:

Uncontrolled diastolic BP

UH:

Uncontrolled hypertension

USBP:

Uncontrolled systolic BP

WMH:

White matter hyperintensities

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Acknowledgments

We would like to thank all the participants of the BRAVE-1 study.

Funding

The study is supported by a grant from Jiangsu Science and Technology Department (BE2017762) to Dr. Junwei Yang.

Author information

Authors and Affiliations

  1. Department of Radiology, University of Washington, Seattle, WA, USA

    Wenjin Liu, Dakota Ortega, Zhensen Chen, Jie Sun & Chun Yuan

  2. Center for Kidney Disease, Second Affiliated Hospital of Nanjing Medical University, 262# Zhongshan North Road, Nanjing, Jiangsu, China

    Xiaoqin Huang, Lulu Wang & Junwei Yang

  3. Department of Radiology, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China

    Xuebing Liu & Haige Li

  4. Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, USA

    Li Chen

  5. Department of Surgery, Division of Vascular Surgery, University of Washington, Seattle, WA, USA

    Thomas S. Hatsukami

Authors
  1. Wenjin Liu
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  2. Xiaoqin Huang
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  5. Li Chen
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  9. Thomas S. Hatsukami
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  11. Haige Li
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Corresponding authors

Correspondence to Haige Li or Junwei Yang.

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Guarantor

The scientific guarantor of this publication is Dr. Junwei Yang

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Dr. Wenjin Liu is supported by NVIDIA Corporation with the donation of the Titan V GPU used for this research.

Statistics and biometry

One of the authors (Dr. Wenjin Liu) has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Methodology

• cross-sectional study

• performed at one institution

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Liu, W., Huang, X., Liu, X. et al. Uncontrolled hypertension associates with subclinical cerebrovascular health globally: a multimodal imaging study. Eur Radiol 31, 2233–2241 (2021). https://doi.org/10.1007/s00330-020-07218-5

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  • DOI: https://doi.org/10.1007/s00330-020-07218-5

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