Reader Response: White Matter Hyperintensities Mediate the Association of Nocturnal Blood Pressure With Cognition

Chesebro et al.1 bring us full circle on the consensus that hypertension is a multisystem illness with small vessel cerebral disease with related parenchymal changes as part of its spectrum. As for animal models of hypertension—and, certainly, now in human chronic hypertension—the position of hypertensive cerebrovascular disease is variable along the dynamic interactions and outcomes that arise once these processes begin. Such realizations are consistent with the recent review that illustrates how peripheral and cerebral autoregulation and reactivity are invariably intertwined in hypertension.2 In reviewing the Classification of Cerebrovascular Diseases published in 1958, Raymond Adams posited, “It must be remembered that in the final analysis the distinguishing attributes of all these diseases are the vascular changes themselves and not merely the parenchymal lesion which they induce.”3 From a clinical and pathology viewpoint, a more complete perspective of hypertension becomes apparent and fundamentally corroborates the 1978 WHO classification of cerebrovascular disease.4 As reiterated by Harsha5 recently, there is danger in assigning imprecise eponyms for cerebrovascular diseases. Rather than being exclusory, it becomes both scientific and practical that hypertension and cerebrovascular disease are spoken of in the same breath.

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