Early markers of structural brain changes in adolescents at different stages of essential arterial hypertension

Aim: To study structural brain changes according to magnetic resonance imaging (MRI) data in adolescents with essential arterial hypertension (AH). A total of 150 12-18-year-old adolescents with essential AH were examined. The average age was 14.9±2.0 years. According to 24-hour blood pressure monitoring, patients were assigned to the following study groups: group 1 comprised 44 patients with “white coat hypertension”; group 2 comprised 50 patients with labile arterial hypertension; group 3 comprised 6 patients with stable AH. MRI study of the brain was performed at MR-imaging unit “Magnetom-OPEN” according to practical standard. The left ventricle function was assessed according to echocardiography data. Activity of von Willebrand factor (vWF) was determined in vitro with reagent kit (“Technology Standard”, Barnaul). Increases in the linear sizes of liquor-contained brain structures were found in 74% of patients. Minimal and moderate signs of hypertensive encephalopathy (HE) were documented in 49.3% and 24.7% of adolescents with essential AH, respectively. An increase in the subarachnoid space of posterior fossa by 0.14 mm (р=0.032) was observed in the presence of average BP increase by 1 mmHg during day hours; systolic blood pressure (SBP) time index increase by one unit (%)corresponded to an increase of in the subarachnoid space of posterior fossa by 0.09 mm (p=0.028) during night hours. The difference in mean values of von Willebrand factor level in the group of adolescents with essential AH and HE reached 18.83% (р=0.025) and was significantly higher than in the group of patients without structural brain disturbances. An increase in the liquor contained brain spaces can be interpreted as early marker of brain damage in the presence of adolescent essential AH. Average BP during the day and a time index of SBP during the night contribute to the development of structural brain disturbances.

подростки, эссенциальная артериальная гипертензия, органы-мишени, головной мозг, adolescents, essential arterial hypertension, target-organs, brain

1. Баркаган З.С., Момот А.П. Диагностика и контролируемая терапия нарушений гемостаза. - М.: Ньюдиамед-АО, 2001. - 296 с.

2. Безляк В.В., Ковалев И.В., Плотникова И.В. Методы многомерного моделирования в детской кардиологии // Педиатрия. - 2010. - Т. 89, № 3. - С. 38-45.

3. Диагностика, лечение и профилактика артериальной гипертензии у детей и подростков // Национальные клинические рекомендации / под ред. Р.Г. Оганова. - М.: Силицея-Полиграф, 2009. - С. 251-288.

4. Дмитриев В.В., Беленков Ю.Н., Арабидзе Г.Г. и др. МР-томография при гипертонической энцефалопатии // Визуализация в клинике. - 1993. - Т. 1(3). - С. 1-4.

5. Карлов В.А., Куликов Ю.А., Ильина Н.Л. и др. Дисциркуляторная энцефалопатия у больных артериальной гипертензией // Журн. невропат. и психиатр. - 1997. - № 5. - С. 15-17.

6. Мордовин В.Ф., Семке Г.В., Афанасьева Н.Л. и др. Церебральная патология у больных с артериальной гипертонией, диагностика и лечение. - Томск: Изд-во Том. ун-та, 2007. -125 с.

7. Шиллер Н.Б., Осипов М.Я. Клиническая эхокардиография. - 2-е изд. - М.: Практика, 2005. - 344 с.

8. Birns J., Morris R., Jarosz J. et al. The structural and functional consequences of diurnal variations in blood pressure in treated patients with hypertensive cerebrovascular disease // J. Hypertens. - 2009. - Vol. 27(5). - P. 1042-1048.

9. Daniels S.R. Hypertension-induced cardiac damage in children and adolescents // Blood Press. Monit. - 1999. - Vol. 4. -P. 165-170.

10. Devereux R.B. Left ventricular geometry, pathophysiology and prognosis // J. Am. Coll. Cardiol. - 1995. - Vol. 25(4). - P. 885887.

11. Everitt B.S., Pickles A. Statistical aspects of the design and analysis of clinical trials. - London: Imperial College Press, 2004. -323 pp.

12. Flynn J.T., Tullus K. Severe hypertension in children and adolescents: pathophysiology and treatment // Pediatr. Nephrol. - 2009. - Vol. 24. - P. 1101-1112.

13. Gumus H., Per H., Kumandas S., Yikilmaz A. Reversible posterior leukoencephalopathy syndrome in childhood: report of nine cases and review of the literature // Neurol. Sci. - 2010. -Vol. 31(2). - P. 125-131.

14. Jones B.V., Egelhoff J.C., Patterson R.J. Hypertensive encephalopathy in children // AJNR Am. J. Neuroradiol. - 1997. - Vol. 18(1). - P. 101-106.

15. Kohara K., Zhao B., Jiang Y. et al. Relation of left ventricular hypertrophy and geometry to asymptomatic cerebrovascular damage in essential hypertension // Am. J. Cardiol. - 1999. -Vol. 83(3). - P. 367-370.

16. McCoy B., King M., Gill D., Twomey E. Childhood posterior reversible encephalopathy syndrome // Eur. J. Paediatric. neurology. - 2011. - Vol. 1. - P. 91-94.

17. Nishio Y., Tsumura K., Kurata C. et al. Hypertensive encephalopathy detected by MRI // No To Shinkei. - 2003. -Vol. 55(1). - P. 78-79.

18. Paglieri C., Rabbia F., Bergui M. et al. Silent cerebrovascular damage and its early correlates in essential hypertensive patients // Clin. Exp. Hypertens. - 2012. - Vol. 34(7). - P. 510-516.

19. Prasad N., Gulati S., Gupta R.K. et al. Spectrum of radiological changes in hypertensive children with reversible posterior leucoencephalopathy // Br. J. Radiol. - 2007. - Vol. 80(954). -P. 422-429.

20. Sharma M., Kupferman J.C., Brosgol Y. et al. The effects of hypertension on the paediatric brain: a justifiable concern // Lancet Neurol. - 2010. - Vol. 9. - P. 933-940.

21. Singhi P., Subramanian C., Jain V. et al. Reversible brain lesions in childhood hypertension // Acta Paediatr. - 2002. - Vol. 91(9). - P. 1005-1007.

22. Van Boxtel M.P., Henskens L.H., Kroon A.A. et al. Ambulatory blood pressure, asymptomatic cerebrovascular damage and cognitive function in essential hypertension // J. Hum. Hypertens. - 2006. - Vol. 20(1). - P. 5-13.

23. Van der Kolka A.G., Hendriksea J., Zwanenburga J.G.M. et al. Clinical applications of 7 T MRI in the brain // Eur. J. Radiology. - 2013. - Vol. 82. - P. 708-718.

24. Veglio F., Paglieri C., Rabbia F. et al. Hypertension and cerebrovascular damage // Atherosclerosis. - 2009. -Vol. 205(2). - P. 331-341.