Pathophysiology of Subclinical Brain Damage in Hypertension: Large Artery Disease

Hypertension induces subclinical damage in the large elastic arteries and in the small brain arteries. Better understanding of the hemodynamic consequences of hypertension on brain structure and function is mandatory, not only to select the most appropriate therapeutic decisions but also to optimize prevention, which should be started early in individuals at high risk of developing brain lesions. This chapter proposes an integrated pathophysiological approach in order to better understand how hypertension-induced large artery damage influences pressure wave transmission, exaggerates subclinical brain damage in the small brain arteries, and leads to cerebrovascular complications. Measurement of arterial stiffness and central blood pressure by non-invasive methods in epidemiological studies and randomized clinical trials have improved our understanding of the hemodynamic consequences of hypertension on the brain, including silent brain lesions such as white matter hyperintensities, and clinical manifestations such as stroke and cognitive decline.