Chronic Hypertension and Cerebral Small Vessel Disease

Hypertension and White Matter Lesions

MRI studies in persons with chronic hypertension have revealed greater numbers of subcortical white matter lesions compared to age-matched controls, according to the American Heart Association 1
Periventricular lesions associated with hypertension typically appear as multiple white matter lesions involving paraventricular regions, suggestive of ischemic small-vessel disease, as reported by the American Academy of Neurology 2
These hypertension-related periventricular lesions often present as symmetric linear hyperintensities abutting the lateral ventricles or periventricular "capping" at the frontal and occipital horns, as described by the American Academy of Neurology 3
Juxtacortical lesions (white matter lesions abutting the cortex) can occur in ischemic small-vessel disease caused by chronic hypertension, with characteristics distinct from those seen in multiple sclerosis, as noted by the American Academy of Neurology 2

Chronic hypertension leads to narrowing and sclerosis of small penetrating arteries in the subcortical regions of the brain, resulting in hypoperfusion, loss of autoregulation, and compromise of the blood-brain barrier, according to the American Heart Association 1
Effective antihypertensive therapy may reduce the risk of developing significant white matter changes on MRI, as recommended by the American College of Cardiology 1
The optimal systolic/diastolic blood pressure to prevent cognitive decline in older individuals is thought to be in the range of 135-150 mmHg systolic and 70-79 mmHg diastolic, as suggested by the American Heart Association 1

Hypertensive white matter lesions differ from multiple sclerosis lesions in several ways, including their shape, orientation, and distribution, as described by the American Academy of Neurology 4
They often present with symmetric distribution rather than the asymmetric pattern seen in MS, and may be accompanied by lacunar infarcts or microbleeds, as noted by the American Academy of Neurology 5
U-fibers (subcortical arcuate fibers) are generally spared by hypertension and cerebrovascular diseases, as reported by the American Academy of Neurology 6