Blood-Borne Biomarkers of Hypertension Predicting Hemorrhagic and Ischemic Stroke

Arterial hypertension is the most prevalent noncommunicable disease worldwide and has long been recognized as a major risk factor for stroke, cognitive decline, and dementia. The main goal for prevention is to identify high-risk patients, targeting the modifiable risk factors, and among these, hypertension is the most powerful one. Screening for subclinical brain deterioration is rarely performed because it requires very expensive and not widely available neuroimaging techniques. The main challenge is to detect asymptomatic brain lesions with noninvasive and cost-effective techniques that can be easily performed and interpreted for widespread screening in the community. In this chapter we present an update on the status of blood-based biomarkers explored as alternatives for early detection of brain damage in neurologically asymptomatic subjects (community studies, arterial hypertension, diabetes mellitus, and elderly individuals) and longitudinal studies to explore their value as long-term predictors of incident acute cerebrovascular events. This would undoubtedly have a very positive effect for primary stroke prevention. Numerous blood biomarkers have been investigated with very controversial results. Nevertheless, blood-based brain-specific biomarkers are beginning to stand out in this field and will probably be able to offer much more in the future for the detection of asymptomatic CSVD and in the long-term prediction of acute cerebrovascular events, due to the fact that they can more directly represent what is occurring in the brain.