From the Research
Hypertensive microangiopathy cavernomas are small vascular malformations that develop in the brain as a result of chronic, poorly controlled hypertension, and their management primarily focuses on aggressive blood pressure control. These lesions form when high blood pressure damages small blood vessels, causing them to weaken, dilate, and form abnormal clusters of thin-walled, blood-filled cavities. Unlike typical cavernomas which are congenital, hypertensive microangiopathy cavernomas are acquired lesions that develop over time due to persistent hypertension. They are often found in deep brain structures, particularly the basal ganglia, thalamus, and brainstem. These lesions can cause microbleeds and may contribute to cognitive decline, stroke-like symptoms, or seizures in some patients. Key aspects of management include:
- Aggressive blood pressure control, typically aiming for levels below 130/80 mmHg
- Use of antihypertensive medications such as ACE inhibitors, ARBs, calcium channel blockers, or diuretics
- Regular neuroimaging follow-up with MRI to monitor for growth or new bleeds
- Surgical intervention is rarely indicated unless there are recurrent symptomatic hemorrhages or progressive neurological deficits that can be directly attributed to a specific lesion, as discussed in the context of cerebral cavernous malformations 1. The choice of antihypertensive medication may involve considering the benefits and risks of different classes of drugs, including the potential for ACE inhibitors to outperform AT-1 antagonists in preventing myocardial infarction and total mortality 2, and the possibility that ARBs may have neuroprotective effects compared to other antihypertensives, including ACE inhibitors 3. Overall, the goal of treatment is to control blood pressure and prevent further damage to the brain, with the choice of specific interventions guided by the individual patient's needs and circumstances.