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Original Research

Is High Blood Pressure Self-Protection for the Brain?

Esther A Warnert, Jonathan C Rodrigues, Amy E Burchell, Sandra Neumann, Laura E Ratcliffe, Nathan E Manghat, Ashley D Harris, Zoe H Adams, Angus K Nightingale, Richard G Wise, Julian F Paton, Emma C Hart
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https://doi.org/10.1161/CIRCRESAHA.116.309493
Circulation Research. 2016;CIRCRESAHA.116.309493
Originally published September 26, 2016
Esther A Warnert
Clinical Neurological Sciences, Western University
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Jonathan C Rodrigues
Clinical Research and Imaging Centre, University Hospitals Bristol NHS Foundation Trust
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Amy E Burchell
Clinical Research and Imaging Centre, University Hospitals Bristol NHS Foundation Trust
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Sandra Neumann
Physiology, University of Bristol
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Laura E Ratcliffe
Physiology, Pharmacology and Neuroscience, University of Bristol
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Nathan E Manghat
Clinical Research and Imaging Centre, NIHR Bristol Cardiovascular Biomedical Research Unit
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Ashley D Harris
Radiology, University of Calgary
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Zoe H Adams
Physiology, Pharmacology and Neuroscience, University of Bristol
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Angus K Nightingale
Clinical Research and Imaging Centre, University Hospitals Bristol NHS Foundation Trust
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Richard G Wise
Cardiff University Brain Research Imaging Centre, Cardiff University
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Julian F Paton
Physiology, Pharmacology and Neuroscience, University of Bristol
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Emma C Hart
Physiology and Pharmacology, University of Bristol
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  • For correspondence: emma.hart@bristol.ac.uk
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Abstract

Rationale: Data from animal models of hypertension indicate that high blood pressure may develop as a vital mechanism to maintain adequate blood flow to the brain. We propose that congenital vascular abnormalities of the posterior cerebral circulation and cerebral hypoperfusion could partially explain the etiology of essential hypertension, which remains enigmatic in 95% of patients.

Objective: To evaluate the role of the cerebral circulation in the pathophysiology of hypertension.

Methods and Results: We completed a series of retrospective and mechanistic case-control magnetic resonance imaging and physiological studies, in normotensive and hypertensive humans (n=259). Interestingly, in humans with hypertension, we report a higher prevalence of congenital cerebrovascular variants; vertebral artery hypoplasia and an incomplete posterior circle of Willis, which were coupled with increased cerebral vascular resistance, reduced cerebral blood flow and a higher incidence of lacunar type infarcts. Causally, cerebral vascular resistance was elevated before the onset of hypertension and elevated sympathetic nerve activity (n=126). Interestingly, untreated hypertensive patients (n=20) had a cerebral blood flow similar to age-matched controls (n=28). However, participants receiving anti-hypertensive therapy (with blood pressure controlled below target levels) had reduced cerebral perfusion (n=19). Finally, elevated cerebral vascular resistance was a predictor of hypertension suggesting it may be a novel prognostic and/or diagnostic marker (n=126). <

Conclusions: Our data indicate that congenital cerebrovascular variants in the posterior circulation and the associated cerebral hypoperfusion may be a factor in triggering hypertension. Therefore lowering blood pressure may worsen cerebral perfusion in susceptible individuals.

  • Veretebral artery hypoplasia
  • cerebral blood flow
  • muscle sympathetic nerve activity
  • cardiac magnetic resonance imaging
  • hypertension, high blood pressure
  • cerebrovascular
  • vertebrobasilar
  • pathophysiology
  • human
  • Received July 6, 2016.
  • Revision received September 22, 2016.
  • Accepted September 26, 2016.
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April 13, 2018, Volume 122, Issue 8
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    Is High Blood Pressure Self-Protection for the Brain?
    Esther A Warnert, Jonathan C Rodrigues, Amy E Burchell, Sandra Neumann, Laura E Ratcliffe, Nathan E Manghat, Ashley D Harris, Zoe H Adams, Angus K Nightingale, Richard G Wise, Julian F Paton and Emma C Hart
    Circulation Research. 2016;CIRCRESAHA.116.309493, originally published September 26, 2016
    https://doi.org/10.1161/CIRCRESAHA.116.309493

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    Is High Blood Pressure Self-Protection for the Brain?
    Esther A Warnert, Jonathan C Rodrigues, Amy E Burchell, Sandra Neumann, Laura E Ratcliffe, Nathan E Manghat, Ashley D Harris, Zoe H Adams, Angus K Nightingale, Richard G Wise, Julian F Paton and Emma C Hart
    Circulation Research. 2016;CIRCRESAHA.116.309493, originally published September 26, 2016
    https://doi.org/10.1161/CIRCRESAHA.116.309493
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