Essential Hypertension, Cerebral White Matter Pathology and Ischemic Stroke
Affiliation: Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clinic of Barcelona, Villarroel 170. Barcelona 08036, Spain.
Keywords: Arterial stiffness, cerebral small vessel disease, circadian rhythm, essential hypertension, intima-media thickness,
pulse wave velocity, stroke, white matter lesions.
Stroke is one of the most-frequent causes of death and the first cause of disability worldwide. Different mechanisms
are related to the pathogenesis of stroke, involving multiple biological systems, which are often inter-connected.
Besides age, hypertension is the most important risk factor for stroke and may also predispose to the development of more
subtle cerebral damage based on arteriolar narrowing or pathological microvascular changes. Age and high blood pressure
are responsible for silent structural and functional cerebral changes leading to white matter lesions and cognitive impairment.
The clinical significance and pathological substrate of white matter lesions are not fully understood. Hypertensive
patients have more white matter lesions, which are an important prognostic factor for the development of stroke, cognitive
impairment, dementia and death, than normotensive people. Over the past 10 years, strong evidence has emerged that
cerebral white matter lesions in hypertensive patients should be considered a silent early marker of brain damage. The
mechanisms that would explain all these relationships remain to be elucidated, but available data suggest that arteriosclerosis
of the penetrating brain vessels is the main factor in the pathogenesis of ischemic white matter lesions.
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