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.

中文翻译：

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血脑屏障完整性随血压升高而降低：7T DCE-MRI 研究。


背景 血脑屏障（BBB）完整性被认为在高血压中因脑内皮功能障碍而受损。高血压先于各种脑血管疾病（例如脑小血管疾病）发生，并且是发生神经退行性疾病的危险因素，而血脑屏障破坏是神经退行性疾病的先导病理生理过程。在这项横断面研究中，我们调查了人类受试者的高血压、当前血压和血脑屏障漏泄之间的关系。方法 使用稀疏时间采样对比增强 7T 磁共振技术，确定 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 渗漏成像协议。对结构性脑小血管疾病标志物进行目测评级。进行多变量回归分析，调整年龄、性别、心血管危险因素和脑小血管疾病标志物，以确定高血压状态、收缩压和舒张压、平均动脉压、药物治疗和血脑屏障渗漏之间的关系。结果高血压和正常血压参与者均表现出轻度脑小血管疾病评分。高血压和正常血压参与者之间的血脑屏障渗漏没有差异；然而，皮质中的收缩压、舒张压和平均动脉压以及灰质中的舒张压和平均动脉压显着较高。接受有效治疗的患者比目前患有高血压的患者表现出更少的血脑屏障渗漏。结论 总灰质和皮质灰质的 BBB 完整性随着血压升高而降低，但与高血压状态无关。 这些发现表明，在出现明显的脑组织损伤之前，血脑屏障已经随着血压升高而发生破坏。此外，我们的结果表明有效的抗高血压药物对血脑屏障具有保护作用。注册网址：https://Trialsearch.who.int/；唯一标识符：NL7537。