Reader response: White matter hyperintensities mediate the association of nocturnal blood pressure with cognition
NevioCimolai, Physician, Faculty of Medicine, The University of British Columbia
Submitted May 25, 2020
Chesebro et al.1 bring us full circle on the consensus that hypertension is a multi-system illness with small vessel cerebral disease with related parenchymal changes as part of its spectrum. As for animal models of hypertension—and, certainly now in human chronic hypertension—the position of hypertensive cerebrovascular disease is variable along the dynamic interactions and outcomes that arise once these processes begin. Such realizations are consistent with the recent review that illustrates how peripheral and cerebral autoregulation and reactivity are invariably intertwined in hypertension.2 In reviewing the Classification of Cerebrovascular Diseases published in 1958, Raymond Adams posited, "It must be remembered that in the final analysis the distinguishing attributes of all these diseases are the vascular changes themselves and not merely the parenchymal lesion which they induce."3
From a clinical and pathology viewpoint, a more complete perspective of hypertension becomes apparent and fundamentally corroborates the 1978 WHO classification of cerebrovascular disease.4 As reiterated by Harsha recently, there is danger in assigning imprecise eponyms for cerebrovascular diseases.5 Rather than being exclusory, it becomes both scientific and practical that hypertension and cerebrovascular disease are spoken of in the same breath.
Disclosure
The author reports no relevant disclosures. Contact journal@neurology.org for full disclosures.
References
Chesebro AG, Melgarejo JD, Leendertz R, et al. White matter hyperintensities mediate the association of nocturnal blood pressure with cognition. Neurology 2020;94:e1803–e1810.
Yazdani N, Kindy MS, Taheri S. CBF regulation in hypertension and Alzheimer’s disease. Clin Exp Hypertens 2020 Epub May 18;1–18.
Adams RD. Recent developments in cerebrovascular diseases. Br Med J 1958;1:785–8.
World Health Organization. Cerebrovascular disorders: a clinical and research classification. WHO Offset Publication;43. Geneva: World Health Organization; 1978.
Harsha KJ. Imprecise Eponyms in Stroke Medicine - A Growing Need for Uniform Terminologies/Definitions Across the Globe. Neurol India 2019;67:364–369.
Chesebro et al.1 bring us full circle on the consensus that hypertension is a multi-system illness with small vessel cerebral disease with related parenchymal changes as part of its spectrum. As for animal models of hypertension—and, certainly now in human chronic hypertension—the position of hypertensive cerebrovascular disease is variable along the dynamic interactions and outcomes that arise once these processes begin. Such realizations are consistent with the recent review that illustrates how peripheral and cerebral autoregulation and reactivity are invariably intertwined in hypertension.2 In reviewing the Classification of Cerebrovascular Diseases published in 1958, Raymond Adams posited, "It must be remembered that in the final analysis the distinguishing attributes of all these diseases are the vascular changes themselves and not merely the parenchymal lesion which they induce."3
From a clinical and pathology viewpoint, a more complete perspective of hypertension becomes apparent and fundamentally corroborates the 1978 WHO classification of cerebrovascular disease.4 As reiterated by Harsha recently, there is danger in assigning imprecise eponyms for cerebrovascular diseases.5 Rather than being exclusory, it becomes both scientific and practical that hypertension and cerebrovascular disease are spoken of in the same breath.
Disclosure
The author reports no relevant disclosures. Contact journal@neurology.org for full disclosures.
References