From the Research
Treatment of microvascular changes seen on brain imaging should focus on managing underlying risk factors and preventing progression, with the primary approach involving controlling hypertension, diabetes management, statin therapy, and lifestyle modifications, as supported by the most recent study 1. The primary approach involves controlling hypertension with medications such as ACE inhibitors (e.g., lisinopril 10-40 mg daily), ARBs (e.g., losartan 25-100 mg daily), or calcium channel blockers (e.g., amlodipine 5-10 mg daily), targeting blood pressure below 130/80 mmHg. Some key points to consider in the treatment of microvascular changes include:
- Diabetes management is essential, aiming for HbA1c below 7%, using medications like metformin, SGLT2 inhibitors, or insulin as appropriate, as mentioned in the context of managing underlying risk factors 1.
- Statins (e.g., atorvastatin 20-40 mg daily) are recommended to control cholesterol levels, which is crucial in preventing the progression of microvascular changes.
- Lifestyle modifications are crucial, including:
- Smoking cessation
- Limiting alcohol intake
- Maintaining a Mediterranean or DASH diet
- Regular physical activity (150 minutes weekly of moderate exercise)
- Weight management
- Antiplatelet therapy with low-dose aspirin (81 mg daily) may be considered for patients with additional cardiovascular risk factors, as suggested by the study 1. These interventions are important because microvascular changes reflect small vessel disease that can lead to cognitive decline, stroke risk, and functional impairment if left untreated, as highlighted in the study 2. Regular follow-up with neuroimaging every 1-2 years helps monitor disease progression and treatment effectiveness, which is supported by the study 3. It is also worth noting that advanced physiological MRI techniques can be used to measure the pathological alterations associated with microvascular rarefaction, as mentioned in the study 1. However, the most recent and highest quality study 1 provides the most relevant guidance for the treatment of microvascular changes seen on brain imaging.