Blood-Brain Barrier Integrity Decreases With Higher Blood Pressure: A 7T DCE-MRI Study.

IF 6.9 1区医学 Q1 PERIPHERAL VASCULAR DISEASE Hypertension Pub Date : 2024-10-01 Epub Date: 2024-08-13 DOI:10.1161/HYPERTENSIONAHA.123.22617

Marieke van den Kerkhof, Joost J A de Jong, Paulien H M Voorter, Alida A Postma, Abraham A Kroon, Robert J van Oostenbrugge, Jacobus F A Jansen, Walter H Backes

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Abstract

Background: Blood-brain barrier (BBB) integrity is presumed to be impaired in hypertension, resulting from cerebral endothelial dysfunction. Hypertension precedes various cerebrovascular diseases, such as cerebral small vessel disease, and is a risk factor for developing neurodegenerative diseases for which BBB disruption is a preceding pathophysiological process. In this cross-sectional study, we investigated the relation between hypertension, current blood pressure, and BBB leakage in human subjects.

Methods: BBB leakage was determined in 22 patients with hypertension and 19 age- and sex-matched normotensive controls (median age [range], 65 [45-80] years; 19 men) using a sparsely time-sampled contrast-enhanced 7T magnetic resonance imaging protocol. Structural cerebral small vessel disease markers were visually rated. Multivariable regression analyses, adjusted for age, sex, cardiovascular risk factors, and cerebral small vessel disease markers, were performed to determine the relation between hypertension status, systolic and diastolic blood pressure, mean arterial pressure, drug treatment, and BBB leakage.

Results: Both hypertensive and normotensive participants showed mild scores of cerebral small vessel disease. BBB leakage did not differ between hypertensive and normotensive participants; however, it was significantly higher for systolic blood pressure, diastolic blood pressure, and mean arterial pressure in the cortex, and diastolic blood pressure and mean arterial pressure in the gray matter. Effectively treated patients showed less BBB leakage than those with current hypertension.

Conclusions: BBB integrity in the total and cortical gray matter decreases with increasing blood pressure but is not related to hypertension status. These findings show that BBB disruption already occurs with increasing blood pressure, before the presence of overt cerebral tissue damage. Additionally, our results suggest that effective antihypertensive medication has a protective effect on the BBB.

Registration: URL: https://trialsearch.who.int/; Unique identifier: NL7537.

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血压升高会降低血脑屏障的完整性：7T DCE-MRI 研究。

背景：据推测，高血压患者的血脑屏障（BBB）完整性受损，导致脑内皮功能障碍。高血压发生在各种脑血管疾病（如脑小血管疾病）之前，是导致神经退行性疾病的危险因素，而BBB破坏是神经退行性疾病的前一个病理生理过程。在这项横断面研究中，我们调查了人体高血压、当前血压与 BBB 渗漏之间的关系：方法：采用稀疏时间采样对比度增强 7T 磁共振成像方案，测定了 22 名高血压患者和 19 名年龄和性别匹配的正常血压对照者（中位年龄 [范围]，65 [45-80] 岁；19 名男性）的 BBB 渗漏情况。对结构性脑小血管疾病标志物进行目测评分。在对年龄、性别、心血管风险因素和脑小血管疾病标志物进行调整后，进行了多变量回归分析，以确定高血压状态、收缩压和舒张压、平均动脉压、药物治疗和 BBB 渗漏之间的关系：结果：高血压患者和血压正常者都有轻微的脑小血管疾病。高血压患者和正常血压患者的 BBB 渗漏没有差异，但收缩压、舒张压和大脑皮层平均动脉压，以及舒张压和灰质平均动脉压均显著升高。与目前患有高血压的患者相比，接受有效治疗的患者显示出更少的BBB渗漏：结论：随着血压的升高，总灰质和皮层灰质中的 BBB 完整性会降低，但与高血压状态无关。这些研究结果表明，随着血压升高，在出现明显的脑组织损伤之前，BBB就已经发生了破坏。此外，我们的研究结果表明，有效的降压药对 BBB 有保护作用：URL: https://trialsearch.who.int/; Unique identifier：NL7537。

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来源期刊

Hypertension 医学-外周血管病

CiteScore

15.90

自引率

4.80%

发文量

1006

审稿时长

1 months

期刊介绍： Hypertension presents top-tier articles on high blood pressure in each monthly release. These articles delve into basic science, clinical treatment, and prevention of hypertension and associated cardiovascular, metabolic, and renal conditions. Renowned for their lasting significance, these papers contribute to advancing our understanding and management of hypertension-related issues.