Course of brain damage following malignant hypertension.

IF 2.7 4区 医学 Q2 PERIPHERAL VASCULAR DISEASE
Jean Sebastien Liegey, Antoine Cremer, Ludovic Lucas, Philippe Gosse, Stéphane Debeugny, Sebastien Rubin, Julien Doublet, Igor Sibon, Romain Boulestreau
{"title":"Course of brain damage following malignant hypertension.","authors":"Jean Sebastien Liegey, Antoine Cremer, Ludovic Lucas, Philippe Gosse, Stéphane Debeugny, Sebastien Rubin, Julien Doublet, Igor Sibon, Romain Boulestreau","doi":"10.1038/s41371-024-00968-5","DOIUrl":null,"url":null,"abstract":"<p><p>Malignant hypertension (MHT) crisis triggers widespread microvascular damage, particularly in the brain. Despite recent MRI evidence highlighting acute cerebral injuries during MHT crises, follow-up data remain scarce. This study seeks to fill this gap by exploring how brain MRI markers evolve following acute MHT crisis management. We conducted a retrospective analysis of brain MRI data from MHT patients admitted to Bordeaux University Hospital between 2008 and 2022. Eligible patients had at least one follow-up MRI. Analysis blinded to clinical data was performed to identify markers of posterior reversible encephalopathy syndrome (PRES), acute stroke, cerebral hemorrhage, and microangiopathy. Out of 149 patients, 47 had follow-up MRIs. Most were male (72.3%) with a mean age of 48.2 ± 10.8 years. The median interval between initial and follow-up MRI was 228 days. Follow-up MRIs revealed new strokes in 10.6% of patients, cerebral hemorrhages in 4.3%, and no cases of PRES. Additionally, more patients exhibited chronic lacunar infarcts and/or microbleeds, with overall Fazekas scores remaining stable in 66.0%, improving in 31.9%, and worsening in 2.1%. Subgroup analyses based on blood pressure control or follow-up duration showed no significant differences in MRI markers. This study sheds light on the risk of new cerebrovascular events and the dynamic changes in brain MRI markers following acute MHT crisis management. Understanding these changes could lead to improved diagnosis, personalized treatment strategies, and proactive patient care for individuals with MHT.</p>","PeriodicalId":16070,"journal":{"name":"Journal of Human Hypertension","volume":null,"pages":null},"PeriodicalIF":2.7000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Human Hypertension","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1038/s41371-024-00968-5","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0

Abstract

Malignant hypertension (MHT) crisis triggers widespread microvascular damage, particularly in the brain. Despite recent MRI evidence highlighting acute cerebral injuries during MHT crises, follow-up data remain scarce. This study seeks to fill this gap by exploring how brain MRI markers evolve following acute MHT crisis management. We conducted a retrospective analysis of brain MRI data from MHT patients admitted to Bordeaux University Hospital between 2008 and 2022. Eligible patients had at least one follow-up MRI. Analysis blinded to clinical data was performed to identify markers of posterior reversible encephalopathy syndrome (PRES), acute stroke, cerebral hemorrhage, and microangiopathy. Out of 149 patients, 47 had follow-up MRIs. Most were male (72.3%) with a mean age of 48.2 ± 10.8 years. The median interval between initial and follow-up MRI was 228 days. Follow-up MRIs revealed new strokes in 10.6% of patients, cerebral hemorrhages in 4.3%, and no cases of PRES. Additionally, more patients exhibited chronic lacunar infarcts and/or microbleeds, with overall Fazekas scores remaining stable in 66.0%, improving in 31.9%, and worsening in 2.1%. Subgroup analyses based on blood pressure control or follow-up duration showed no significant differences in MRI markers. This study sheds light on the risk of new cerebrovascular events and the dynamic changes in brain MRI markers following acute MHT crisis management. Understanding these changes could lead to improved diagnosis, personalized treatment strategies, and proactive patient care for individuals with MHT.

恶性高血压的脑损伤过程。
恶性高血压(MHT)危象会引发广泛的微血管损伤,尤其是在脑部。尽管最近的磁共振成像证据突出显示了 MHT 危机期间的急性脑损伤,但随访数据仍然很少。本研究试图通过探索急性 MHT 危机处理后脑部 MRI 标记的演变情况来填补这一空白。我们对 2008 年至 2022 年期间波尔多大学医院收治的 MHT 患者的脑磁共振成像数据进行了回顾性分析。符合条件的患者至少接受过一次磁共振成像随访。对临床数据进行了盲法分析,以确定后可逆性脑病综合征(PRES)、急性中风、脑出血和微血管病变的标志物。在 149 名患者中,47 人进行了磁共振成像随访。大多数患者为男性(72.3%),平均年龄(48.2 ± 10.8)岁。初次磁共振成像与随访磁共振成像之间的中位间隔为 228 天。随访磁共振成像结果显示,10.6%的患者出现了新的中风,4.3%的患者出现了脑出血,但没有发现 PRES 病例。此外,更多患者表现为慢性腔隙性脑梗塞和/或微小出血,66.0%的患者法泽卡斯评分保持稳定,31.9%的患者评分有所改善,2.1%的患者评分恶化。基于血压控制或随访时间的亚组分析显示,磁共振成像标记物没有显著差异。这项研究揭示了新脑血管事件的风险以及急性 MHT 危机处理后脑部 MRI 指标的动态变化。了解这些变化有助于改进诊断、个性化治疗策略和对 MHT 患者的前瞻性护理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Journal of Human Hypertension
Journal of Human Hypertension 医学-外周血管病
CiteScore
5.20
自引率
3.70%
发文量
126
审稿时长
6-12 weeks
期刊介绍: Journal of Human Hypertension is published monthly and is of interest to health care professionals who deal with hypertension (specialists, internists, primary care physicians) and public health workers. We believe that our patients benefit from robust scientific data that are based on well conducted clinical trials. We also believe that basic sciences are the foundations on which we build our knowledge of clinical conditions and their management. Towards this end, although we are primarily a clinical based journal, we also welcome suitable basic sciences studies that promote our understanding of human hypertension. The journal aims to perform the dual role of increasing knowledge in the field of high blood pressure as well as improving the standard of care of patients. The editors will consider for publication all suitable papers dealing directly or indirectly with clinical aspects of hypertension, including but not limited to epidemiology, pathophysiology, therapeutics and basic sciences involving human subjects or tissues. We also consider papers from all specialties such as ophthalmology, cardiology, nephrology, obstetrics and stroke medicine that deal with the various aspects of hypertension and its complications.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信