Hypertension, cerebral vascular changes and stroke in Ghana. 1. Microaneurysm formation and stroke

Abstract

A modification of the post-mortem arteriographic technique of Ross Russell was used to study the brains of 284 consecutive autopsy cases dying from non-traumatic causes; and made up of 159 hypertensives and 125 normotensives. Microaneurysms were demonstrated in 30.8 per cent of the hypertensives compared with 9.6 per cent normotensives. Haemorrhagic stroke was the cause of death in 37.6 per cent of the hypertensives, the majority of which were in younger age groups compared with hypertensive strokes in whites. The much lower incidence of microaneurysms in the brain of black hypertensives (even those with haemorrhagic strokes) compared with that found by workers among white hypertensives further emphasized the different nature of hypertension in blacks. It is suggested that, in the absence of significant structural differences in the cerebral vasculature between blacks and whites, the high incidence of haemorrhagic strokes occurring in the relatively younger subjects in Ghana may be due to the direct effect of high blood pressures on small intracerebral vessels and that microaneurysm formation may not be as important as in the much older white subjects dying of haemorrhagic strokes.