Association of HTN with Silent Brain Infarcts on MRI in Asymptomatic Patients
DOI:
https://doi.org/10.63682/jns.v13i1.8427Keywords:
Asymptomatic Patients, HTN, SBIsAbstract
Background: Hypertension (HTN) is a well-established risk factor for cerebrovascular disease, including the occurrence of silent brain infarcts (SBIs), which are often subclinical and asymptomatic.
Objective: The objective of this study was to assess the association between HTN and the prevalence of SBIs in asymptomatic patients.
Methods: This cross-sectional observational study was conducted at Isra University Hyderabad during November 2023 to September 2024. A total of 85 patients were included in this study. Demographic variables such as age, gender, and relevant clinical data, including the duration of hypertension, were collected. Blood pressure measurements were taken, and information on comorbidities such as smoking, diabetes, and dyslipidemia was obtained.
Results: Among the 85 participants, 31 (37%) had silent brain infarcts. The prevalence of SBIs was significantly higher in patients with Stage 2 hypertension (47%) compared to Stage 1 hypertension (30%). The prevalence of SBIs also increased with the duration of hypertension, with 52% of patients with hypertension lasting more than 10 years showing SBIs. There was no significant difference in the presence of SBIs between patients on antihypertensive medication and those not on medication (p = 0.50). Comorbidities such as smoking and diabetes were also associated with a higher prevalence of SBIs.
Conclusions: It is concluded that hypertension, particularly long-standing and severe cases, is significantly associated with the presence of silent brain infarcts in asymptomatic patients.
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Riba-Llena, I., Jarca, C.I., Mundet, X. et al. Investigating silent strokes in hypertensives: a magnetic resonance imaging study (ISSYS): rationale and protocol design. BMC Neurol 13, 130 (2013). https://doi.org/10.1186/1471-2377-13-130
Pascot, R., Daoudal, A., Cardon, A., Godet, G., Lucas, A., Clochard, E., Gauvrit, J., Le Teurnier, Y., & Kaladji, A. (2017). Evaluation by Magnetic Resonance Imaging of Silent Brain Infarcts in Preoperative and Postoperative Asymptomatic Carotid Surgery. Annals of Vascular Surgery, 43, 258-264. https://doi.org/10.1016/j.avsg.2016.10.067
Ruinan Zhang, Dongxiao Yao, Xueli Cai, Yanli Zhang, Yingying Yang, Shan Li, Jing Jing, Suying Wang, Yongjun Wang, Yuesong Pan, Yilong Wang, Prevalence and risk factors of covert brain infarction: A community-based cross-sectional study, International Journal of Stroke, (2024).https://doi.org/10.1177/17474930241313435
Russo E, Leo A, Scicchitano F, Donato A, Ferlazzo E, Gasparini S, et al. Cerebral small vessel disease predisposes to temporal lobe epilepsy in spontaneously hypertensive rats. Brain Res Bull 2017;130:245-250.
Riba-Llena I, Jarca CI, Mundet X, Tovar JL, Orfila F, López-Rueda A, Nafría C, Fernández JL, Castañé X, Domingo M, Alvarez-Sabín J, Fernández-Cortiñas I, Maisterra O, Montaner J, Delgado P. Investigating silent strokes in hypertensives: a magnetic resonance imaging study (ISSYS): rationale and protocol design. BMC Neurol. 2013 Oct 2;13:130. doi: 10.1186/1471-2377-13-130. PMID: 24083440; PMCID: PMC3852223.
Delgado P, Riba-Llena I, Tovar JL, Jarca CI, Mundet X, López-Rueda A, Orfila F, Llussà J, Manresa JM, Alvarez-Sabín J, Nafría C, Fernández JL, Maisterra O, Montaner J; ISSYS Investigators*. Prevalence and associated factors of silent brain infarcts in a Mediterranean cohort of hypertensives. Hypertension. 2014 Sep;64(3):658-63. doi: 10.1161/HYPERTENSIONAHA.114.03563. Epub 2014 Jun 23. PMID: 24958500.
Jiménez-Balado J, Riba-Llena I, Nafría C, Pizarro J, Rodríguez-Luna D, Maisterra O, Ballvé A, Mundet X, Violan C, Ventura O, Montaner J, Delgado P. Silent brain infarcts, peripheral vascular disease and the risk of cardiovascular events in patients with hypertension. J Hypertens. 2022 Aug 1;40(8):1469-1477. doi: 10.1097/HJH.0000000000003154. Epub 2022 Jul 5. PMID: 35881448.
Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2018; 138:e426–e483.
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39:3021–3104.
Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International Society of Hypertension Global Hypertension practice guidelines. Hypertension (Dallas, Tex: 1979) 2020; 75:1334–1357.
Faraco G, Iadecola C. Hypertension: a harbinger of stroke and dementia. Hypertension 2013; 62:810–817.
Arboix A, Marti-Vilalta JL. Lacunar stroke. Expert Rev Neurother 2009; 9:179–196.
Debette S, Markus HS. The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ 2010; 341:c3666.
Gupta A, Giambrone AE, Gialdini G, Finn C, Delgado D, Gutierrez J, et al. Silent brain infarction and risk of future stroke: a systematic review and meta-analysis. Stroke 2016; 47:719–725.
Gioia LC, Tollard É, Dubuc V, Lanthier S, Deschaintre Y, Chagnon M, Poppe AY. Silent ischemic lesions in young adults with first stroke are associated with recurrent stroke. Neurology 2012; 79:1208–1214.
Di Tullio MR, Jin Z, Russo C, Elkind MSV, Rundek T, Yoshita M, et al. Patent foramen ovale, subclinical cerebrovascular disease, and ischemic stroke in a population-based cohort. J Am Coll Cardiol 2013; 62:35–41.
Silent brain infarction in nonrheumatic atrial fibrillation. EAFT Study Group. Eur Atrial Fibrillation Trial. Neurology 1996; 46:159–165.
Leung LY, Han PKJ, Lundquist C, Weinstein G, Thaler DE, Kent DM. Clinicians’ perspectives on incidentally discovered silent brain infarcts - a qualitative study. PLoS One 2018; 13:e0194971.
Potter GM, Chappell FM, Morris Z, Wardlaw JM. Cerebral perivascular spaces visible on magnetic resonance imaging: development of a qualitative rating scale and its observer reliability. Cerebrovasc Dis 2015; 39:224–231.
Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019; 74:1376–1414.
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