Searching cerebrovascular risk indicators for hypertensive patients: Is Framingham Stroke Risk Profile “the magic bullet”?

Abstract

Arterial hypertension is one of the main risk factors for cerebrovascular diseases; even a 10% reduction of diastolic pressure offers a 40% reduction of death from cerebrovascular diseases.1 However, morbidity has not been reduced to a similar extent and an increasing number of patients suffer from recurring strokes and develop progressive cognitive impairment and dementia. Longitudinal studies have shown that arterial hypertension in adult life is a predictive factor for both vascular and degenerative dementia in the elderly and the prevention of cognitive decline and dementia is one of the main goals of antihypertensive therapy. 5 Arterial hypertension causes cognitive impairment and dementia by affecting both the large and small cerebral vessels as well as the heart. The macrovascular atherosclerotic disease causes atherothrombotic brain infarcts that can be either silent or clinically evident as stroke. The microvascular disease results in chronic ischemic changes affecting, to a large extent, the white matter, also known as white matter lesions (WML).