Aldosteronism is associated with more severe cerebral small vessel disease in hypertensive intracerebral hemorrhage

Hypertens Res. 2024 Mar;47(3):608-617. doi: 10.1038/s41440-023-01458-w. Epub 2023 Nov 22.

Abstract

Primary aldosteronism is associated with various types of cardiovascular and cerebrovascular damage independently of hypertension. Although chronic hypertension and related cerebral arteriosclerosis are the main risk factors for intracerebral hemorrhage, the effects of aldosteronism remain poorly understood. We enrolled 90 survivors of hypertensive intracerebral hemorrhage, 21 of them with aldosteronism and 69 with essential hypertension as controls in this study. Clinical parameters and neuroimaging markers of cerebral small vessel disease were recorded, and its correlations with aldosteronism were investigated. Our results showed that the aldosteronism group (55.2 ± 9.7 years, male 47.6%) had similar hypertension severity but exhibited a higher cerebral microbleed count (interquartile range) (8.5 [2.0‒25.8] vs 3 [1.0‒6.0], P = 0.005) and higher severity of dilated perivascular space in the basal ganglia (severe perivascular space [number >20], 52.4% vs. 24.6%, P = 0.029; large perivascular space [>3 mm], 52.4% vs. 20.3%, P = 0.010), compared to those with essential hypertension (53.8 ± 11.7 years, male 73.9%). In multivariate models, aldosteronism remained an independent predictor of a higher (>10) microbleed count (odds ratio = 8.60, P = 0.004), severe perivascular space (odds ratio = 4.00, P = 0.038); the aldosterone-to-renin ratio was associated with dilated perivascular space (P = 0.043) and large perivascular space (P = 0.008). In conclusions, survivors of intracerebral hemorrhage with aldosteronism showed a tendency towards more severe hypertensive arteriopathy than the essential hypertension counterparts independently of blood pressure; aldosteronism may contribute to dilated perivascular space around the deep perforating arteries. Aldosteronism is associated with more severe cerebral small vessel disease in hypertensive intracerebral hemorrhage.

Keywords: Cerebral small vessel disease; Hypertension; Intracerebral hemorrhage; Perivascular space; Primary aldosteronism.

MeSH terms

  • Cerebral Hemorrhage / complications
  • Cerebral Hemorrhage / diagnostic imaging
  • Cerebral Small Vessel Diseases* / complications
  • Cerebral Small Vessel Diseases* / diagnostic imaging
  • Essential Hypertension
  • Humans
  • Hyperaldosteronism* / complications
  • Hypertension* / complications
  • Intracranial Hemorrhage, Hypertensive* / diagnostic imaging
  • Intracranial Hemorrhage, Hypertensive* / etiology
  • Magnetic Resonance Imaging
  • Male