On the origin of cerebral small vessel disease: MRI markers of cSVD in young adults with hypertension

• cSVD MRI markers are already visible in young patients with hypertension. • White matter hyperintensities were more prevalent than lacunes and microbleeds. • High blood pressure should be monitored and treated in adults to prevent damage. • Studying young patients with hypertension may offer insights into cSVD onset. Cerebral small vessel disease (cSVD) contributes to stroke and cognitive decline, with MRI markers of cSVD increasing with age. Hypertension is an important risk factor for cSVD in older adults but its impact in younger individuals remains less clear. This study investigates whether MRI markers of cSVD are more prevalent in young hypertensive individuals compared to normotensive controls. In this cross-sectional study, 60 patients with hypertension and 21 controls aged 18–55 years underwent 3T MRI to assess cSVD markers: white matter hyperintensities (WMH), lacunes, and microbleeds. Group differences were assessed using t -tests, chi-square tests, or non-parametric methods. We examined associations between blood pressure and cSVD markers using multivariable regression models, including linear, logistic, ordinal logistic, and penalized logistic regression, adjusting for potential confounders. Patients with hypertension were older (median (IQR) 35.6 (29.6–41.4) years vs 29.2 (27.8–33.2) years), had a higher BMI, and lower education levels while proportion of females was similar. Deep WMH burden was significantly higher in hypertensive participants (median Fazekas score: 1 [IQR: 0–1] vs 0 [IQR: 0–0]; p < 0.001). Hypertension increased odds of deep WMH (OR 5.49, p = 0.011). Lacunes and microbleeds were rare and observed only in hypertensive participants. Duration since hypertension diagnosis was not significantly associated with WMH volume (β=7.27, p = 0.111) after adjusting for age. WMH are more prevalent in young adults with hypertension, suggesting early microvascular brain changes. These findings underscore the importance of early detection and treatment of hypertension to potentially prevent long-term cerebrovascular changes.