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Markers of subclinical vascular disease, including arterial stiffness and carotid intima-media thickness, are seen as emerging markers of arterial aging and may serve as risk markers for brain injury and vascular cognitive impairment.1 Arterial stiffening, especially of the aorta, plays a key role in the initiation and progression of hypertension. It also directly relates the effects of hypertension to peripheral organs, with dire consequences for organs with extensive microvasculature like the kidney and brain.2 Hypertension contributes to the formation of atheromatous plaques in larger arteries3; directly causes vascular remodeling, lumen narrowing, and rarefaction of small vessels4; and ultimately leads to the impairment of vascular function. The underlying stiffening of the aorta transmits more pulsatile pressure farther into the periphery. High pulsatile flow within the microvasculature causes damage to the endothelium with shedding of endothelial cells. In the brain, this leads to microinfarction, lacunar stroke, cerebral microbleeds, and white matter hyperintensities on MRI.1
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- © 2014 American Academy of Neurology
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