Arterial hypertension and the brain: pathophysiological mechanisms of cerebrovascular injury, management strategies in the acute phase of stroke, and immunological triggers of cognitive impairment

Savchuk O.I.

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Arterial hypertension and the brain: pathophysiological mechanisms of cerebrovascular injury, management strategies in the acute phase of stroke, and immunological triggers of cognitive impairment

November 5, 2026

Savchuk O.I.

УДК: УДК 616.12-008.331.1:616.831

DOI: DOI:10.32471/umj.1680-3051.282251

Keywords :

arterial hypertension,

Brain,

CD8+ T cells,

cerebral small vessel disease,

cognitive impairment,

haemorrhagic stroke,

ischaemic stroke,

mechanical thrombectomy,

MRI tractography,

residual cardiovascular risk

Resume

This scientific review provides a comprehensive overview of current evidence on the effects of systemic arterial hypertension (AH) on the brain, as presented at ESC Congress 2026. It examines the pathophysiological mechanisms underlying cerebral microvascular injury, including endothelial dysfunction, vascular remodelling, and increased pulsatile haemodynamic load. Approaches to antihypertensive therapy in the acute phase of ischaemic and haemorrhagic stroke are analysed in the context of clinical trial and meta-analysis findings. Particular attention is given to the mechanisms of cognitive decline associated with chronic pressure overload, including brain microstructural alterations and immunovascular interactions involving CD8+ T cells and cytokines. The review also highlights the concept of residual cardiovascular risk and the emerging potential of early organ protection.

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