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.