Published online before print February 4, 2008, doi: 10.1161/HYPERTENSIONAHA.107.109355
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Hypertension. 2008;51:e21.)
© 2008 American Heart Association, Inc.
Letters to the Editor |
Response to Brain Microbleeds, Amyloid Plaques, Intellectual Deterioration, and Arterial Stiffness
Department of Internal Medicine, Division of General Internal Medicine, Subdivision of Vascular Medicine, University Hospital Maastricht and Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
Department of Neurology, University Hospital Maastricht and Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
Department of Internal Medicine, Division of General Internal Medicine, Subdivision of Vascular Medicine, University Hospital Maastricht and Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
Department of Neurology, University Hospital Maastricht and Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
We thank O’Rourke1 for the interest in our work2 and for placing our findings into a broader perspective. The mechanisms linking hypertension, cerebral small-vessel disease, and cognitive deterioration are complex and not well understood.3 Arterial stiffening, as speculated on by O’Rourke,1 may be one component, but this remains to be determined definitely in adequately powered and preferably longitudinal studies. In any case, from our cross-sectional study with a limited number of patients displaying brain microbleeds, and in which we did not include markers of arterial stiffening, no reliable conclusions can be drawn on this possible mechanism.2
Yet, we do support the view that brain microbleeds, in addition to other hypertension-related ischemic brain damage, such as white matter hyperintensities and silent brain infarcts, whatever the underlying mechanism, can accelerate age-related cognitive deterioration.4–6 Prospective data, demonstrating an increased risk of future (recurrent) stroke in the presence of microbleeds, white matter hyperintensities, and/or silent infarcts, further emphasize the prognostic importance of silent brain ischemia.4–6 This, in our opinion, justifies the recognition and recommended use (not yet according to current hypertension guidelines) of silent ischemic brain damage as an additional (other than cardiac and renal involvement) and independent marker of organ damage in patients with hypertension.
 |
Acknowledgments |
|---|
Disclosures
None.
|
References |
|---|
 Top References |
|---|
1. O’Rourke. Brain microbleeds, amyloid plaques, intellectual deterioration and arterial stiffness. Hypertension. 2008; 51: e20.
2. Henskens LH, van Oostenbrugge RJ, Kroon AA, de Leeuw PW, Lodder J. Brain microbleeds are associated with ambulatory blood pressure levels in a hypertensive population. Hypertension. 2008; 51: 62–68.
3. Cherubini A, Lowenthal DT, Paran E, Mecocci P, Williams LS, Senin U. Hypertension and cognitive function in the elderly. Am J Ther. 2007; 14: 533–554.[CrossRef][Medline] [Order article via Infotrieve]
4. 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.
5. Sierra C. Cerebral white matter lesions in essential hypertension. Curr Hypertens Rep. 2001; 3: 429–433.[Medline] [Order article via Infotrieve]
6. Vermeer SE, Longstreth WT Jr, Koudstaal PJ. Silent brain infarcts: a systematic review. Lancet Neurol. 2007; 6: 611–619.[CrossRef][Medline] [Order article via Infotrieve]
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||