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Course of brain damage following malignant hypertension

Journal of Human Hypertension volume 39, pages 38–45 (2025)Cite this article

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Abstract

Malignant hypertension (MHT) crisis triggers widespread microvascular damage, particularly in the brain. Despite recent MRI evidence highlighting acute cerebral injuries during MHT crises, follow-up data remain scarce. This study seeks to fill this gap by exploring how brain MRI markers evolve following acute MHT crisis management. We conducted a retrospective analysis of brain MRI data from MHT patients admitted to Bordeaux University Hospital between 2008 and 2022. Eligible patients had at least one follow-up MRI. Analysis blinded to clinical data was performed to identify markers of posterior reversible encephalopathy syndrome (PRES), acute stroke, cerebral hemorrhage, and microangiopathy. Out of 149 patients, 47 had follow-up MRIs. Most were male (72.3%) with a mean age of 48.2 ± 10.8 years. The median interval between initial and follow-up MRI was 228 days. Follow-up MRIs revealed new strokes in 10.6% of patients, cerebral hemorrhages in 4.3%, and no cases of PRES. Additionally, more patients exhibited chronic lacunar infarcts and/or microbleeds, with overall Fazekas scores remaining stable in 66.0%, improving in 31.9%, and worsening in 2.1%. Subgroup analyses based on blood pressure control or follow-up duration showed no significant differences in MRI markers. This study sheds light on the risk of new cerebrovascular events and the dynamic changes in brain MRI markers following acute MHT crisis management. Understanding these changes could lead to improved diagnosis, personalized treatment strategies, and proactive patient care for individuals with MHT.

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Fig. 1: Flow chart.
Fig. 2: Dynamic changes in microvascular lesions among 47 patients with malignant hypertension according to baseline and follow-up brain MRI.
Fig. 3: Follow-up brain MRI of two patients (FLAIR sequence).

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank Ray Cooke for reviewing the English in the manuscript, and Christel Baigts for editing.

Author information

Authors and Affiliations

  1. Coronary and vascular diseases Department, Bordeaux university Hospital, Bordeaux, France

    Jean Sebastien Liegey & Romain Boulestreau

  2. Hypertension Excellence center, Bordeaux University Hospital, Bordeaux, France

    Antoine Cremer, Philippe Gosse & Julien Doublet

  3. Stroke center, Bordeaux University Hospital, Bordeaux, France

    Ludovic Lucas & Igor Sibon

  4. Blood pressure clinic, Cardiology department, Bordeaux University Hospital, Bordeaux, France

    Stéphane Debeugny

  5. Nephrology department, Bordeaux University Hospital, Bordeaux, France

    Sebastien Rubin

  6. Univ. Bordeaux, INSERM, Biologie des maladies cardiovasculaires, U1034, F-33600, Pessac, France

    Sebastien Rubin & Romain Boulestreau

  7. INI-CRCT network, Paris, France

    Romain Boulestreau

Authors
  1. Jean Sebastien Liegey
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  2. Antoine Cremer
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  3. Ludovic Lucas
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  4. Philippe Gosse
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  5. Stéphane Debeugny
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  6. Sebastien Rubin
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  7. Julien Doublet
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  8. Igor Sibon
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  9. Romain Boulestreau
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Contributions

RB was responsible for study design and conception, patient follow-up, data collection, data analysis and manuscript redaction and review. JSL was responsible for critical analysis of final data and manuscript redaction. AC, PG, JD were responsible for patient follow-up, data collection, critical input and manuscript review. LL was responsible for radiological analysis and manuscript review. SD, SR and IS were responsible for critical input and manuscript review. All authors provided critical feedback and helped shape the research, analysis and manuscript.

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Correspondence to Jean Sebastien Liegey.

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Liegey, J.S., Cremer, A., Lucas, L. et al. Course of brain damage following malignant hypertension. J Hum Hypertens 39, 38–45 (2025). https://doi.org/10.1038/s41371-024-00968-5

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