Cerebrovascular Variants in Posterior Circulation
A Potential Cause of Essential Hypertension
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Ever since the identification of hypertension around 150 years ago, researchers have struggled to find its cause(s) with only minor successes.1 Essential, or primary, or idiopathic hypertension is historically defined as a rise in blood pressure (BP) without any known causes, which still accounts for ≈95% of all hypertension.2 Whereas multiple risk factors for hypertension, including genetic variations, obesity, insulin resistance, high alcohol intake, and stress, have been identified, primary causes for hypertension remain elusive. Also, the predictive factors for its development are unclear.3–5 Given that essential hypertension is one of the major modifiable cardiovascular risk factors, uncovering its possible root causative mechanism(s) would have a tremendous public health impact, including prediction or even prevention of the development of the disease. Furthermore, hypertension is refractory to treatment in ≤20% to 30% of cases despite the availability of numerous classes of antihypertensives, and finding primary cause could improve treatment of refractory hypertension.6 Renovascular disease is a well-described cause of hypertension, which is caused by the increase in renin secretion with subsequent increase in angiotensin and aldosterone but is found to be a primary cause in a minority of cases.7 While there is evidence for the involvement of elevated sympathetic nerve activity, the initiating cause has not been established.8 Early on, one of the proposed pathologic hypotheses has been that the increase in BP is an essential response to thickened and narrowed blood vessels to provide more blood supply to organs. This line of pathologic investigation has been mired in the classic difficulty of determining if …