New Insights Into Cerebrovascular Pathophysiology and Hypertension

Abstract

Despite advances in acute management and prevention of cerebrovascular disease, stroke and vascular cognitive impairment together remain the world’s leading cause of death and neurological disability. Hypertension and its consequences are associated with over 50% of ischemic and 70% of hemorrhagic strokes but despite good control of blood pressure (BP), there remains a 10% risk of recurrent cerebrovascular events, and there is no proven strategy to prevent vascular cognitive impairment. Hypertension evolves over the lifespan, from predominant sympathetically driven hypertension with elevated mean BP in early and mid-life to a late-life phenotype of increasing systolic and falling diastolic pressures, associated with increased arterial stiffness and aortic pulsatility. This pattern may partially explain both the increasing incidence of stroke in younger adults as well as late-onset, chronic cerebrovascular injury associated with concurrent systolic hypertension and historic mid-life diastolic hypertension. With increasing arterial stiffness and autonomic dysfunction, BP variability increases, independently predicting the risk of ischemic and intracerebral hemorrhage, and is potentially modifiable beyond control of mean BP. However, the interaction between hypertension and control of cerebral blood flow remains poorly understood. Cerebral small vessel disease is associated with increased pulsatility in large cerebral vessels and reduced reactivity to carbon dioxide, both of which are being targeted in early phase clinical trials. Cerebral arterial pulsatility is mainly dependent upon increased transmission of aortic pulsatility via stiff vessels to the brain, while cerebrovascular reactivity reflects endothelial dysfunction. In contrast, although cerebral autoregulation is critical to adapt cerebral tone to BP fluctuations to maintain cerebral blood flow, its role as a modifiable risk factor for cerebrovascular disease is uncertain. New insights into hypertension-associated cerebrovascular pathophysiology may provide key targets to prevent chronic cerebrovascular disease, acute events, and vascular cognitive impairment.

Treatment of Hypertension by Using Natural Herbs and their Mechanism of Action

“…Hypertension (HTN) mechanism is not fully understood, especially for essential hypertension (Webb & Werring, 2022). Hypertension is a disorder of blood regulation; the failure of the kidneys to secrete sodium promotes the excretion of natriuretic factors like atrial natriuretic factor; The overactive reninangiotensin system causes vasoconstriction and accumulation of sodium and water (Chia, 2022).…”

Hypertension, Neurovascular Dysfunction, and Cognitive Impairment

“…In animal models, as in humans, hypertension has been linked to structural vascular wall alterations. 14,15 Hypertension is associated with or preceded by arterial stiffening, 16,17 caused by various factors including collagen deposition and elastin fragmentation. 18 This can increase pulse pressure and mechanical stress being transferred through the cerebrovascular tree resulting in adaptive changes aimed at protecting the downstream microcirculation.…”

Effects of physical exercise associated with a diet enriched with natural antioxidants on cerebral hypoperfusion and reperfusion injury in spontaneously hypertensive rats

“…Large amounts of data indicate that the increased arterial blood pressure on the vessel walls is correlated to a greater risk of cardiovascular damage, such as brain ischemic injury ( Iadecola and Davisson, 2008 ; Pires et al, 2013 ; Webb and Werring 2018 ). It has been reported that about 87% of transient ischemic attacks/minor strokes (TIAs/MSs) are caused by narrowed or obstructed blood vessels in the brain cutting off the blood flow to neurons ( Ganzer et al, 2016 ; Yu and Coutts 2018 ; Panuganti et al, 2022 ).…”