Cerebral Autoregulation and Blood Pressure Lowering
2007; Lippincott Williams & Wilkins; Volume: 49; Issue: 5 Linguagem: Inglês
10.1161/hypertensionaha.107.087502
ISSN1524-4563
AutoresSean Ruland, Venkatesh Aiyagari,
Tópico(s)Traumatic Brain Injury and Neurovascular Disturbances
ResumoHomeHypertensionVol. 49, No. 5Cerebral Autoregulation and Blood Pressure Lowering Free AccessEditorialPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessEditorialPDF/EPUBCerebral Autoregulation and Blood Pressure Lowering Sean Ruland and Venkatesh Aiyagari Sean RulandSean Ruland From the Department of Neurology and Rehabilitation, University of Illinois College of Medicine, Chicago. and Venkatesh AiyagariVenkatesh Aiyagari From the Department of Neurology and Rehabilitation, University of Illinois College of Medicine, Chicago. Originally published12 Mar 2007https://doi.org/10.1161/HYPERTENSIONAHA.107.087502Hypertension. 2007;49:977–978Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: March 12, 2007: Previous Version 1 Despite its comparatively small size, the brain receives a disproportionate amount of blood flow compared with most other organ systems. Cerebral blood flow is closely coupled to brain metabolism and can be affected by respiratory-induced CO2 changes and arterial blood pressure. Autoregulation is the intrinsic capacity of resistance vessels in end organs, such as heart, kidney, and brain, to dilate and constrict in response to dynamic perfusion pressure changes, maintaining blood flow relatively constant (Figure). This rapid vascular response occurs within seconds of arterial pressure fluctuations. The exact mediators of cerebral autoregulation are not completely understood. However, neurogenic stimuli; metabolic factors, such as adenosine accumulation during low perfusion; and direct intravascular pressure effects on smooth muscle or mediated via endothelial-derived relaxation factor (ie, NO) and constriction factor (ie, endothelin-1) have been implicated.1Download figureDownload PowerPointAutoregulation maintains cerebral blood flow relatively constant between 50 and 150 mm Hg mean arterial pressure. The range is right shifted in chronically hypertensive patients.The cerebral resistance vessels in normotensive individuals are known to autoregulate across a broad range of mean arterial pressures. Perfusion pressures below the lower limit result in initially increased oxygen extraction from hemoglobin and, subsequently, global ischemia. Pressures above the upper bound may result in breakthrough edema, hemorrhage, seizures, and posterior leukoencephalopathy (ie, hypertensive encephalopathy). The normal autoregulatory curve may be right shifted in chronically hypertensive patients, although the magnitude and duration over which this occurs cannot be determined on an individual basis. Hypertensive animal models have shown impaired endothelium-dependent relaxation in the basilar artery, middle cerebral arteries, and cerebral arterioles compared with controls. Studies have also suggested that this impairment is reversible with blood pressure–lowering therapy. However, the potential for acute hypoperfusion is a concern when initiating blood pressure–lowering treatment, considering the unknown lower limit of an individual hypertensive patient's autoregulation. Impaired autoregulation and the adverse effects of acute blood pressure lowering have been clearly shown for those with malignant hypertension, although other groups, such as the elderly, those with deep white matter ischemic disease, and those with cognitive impairment, are thought to be at higher risk because of similar, albeit less profound, vascular impairment.2In this issue of Hypertension, Zhang et al3 elaborately investigate the hemodynamic response to blood pressure lowering in those with mild and moderate hypertension. At 2 weeks and 3 months after initiation of therapy, there was no detectable difference in cerebral blood flow and autoregulatory response to orthostatic challenge as assessed with continuous transcranial Doppler ultrasonography of the middle cerebral artery compared with normotensive control subjects. Of note, the hypertensive patients achieved mean 24-hour blood pressure control similar to normotensive patients within the first 2 weeks of therapy.3 These findings are reassuring given the recommendations for increasingly aggressive therapeutic strategies and treatment goals.4These data should be interpreted with caution considering the relatively small sample, young age, and unknown duration of pre-existing hypertension. Although the statistical differences between groups were not significant, individual subject data were not reported. Furthermore, a standardized method for dynamically assessing autoregulation has not been established, limiting direct comparison and interpretation of existing studies. The transcranial Doppler ultrasonography assessment technique allows convenient continuous noninvasive monitoring of flow velocities concomitant with blood pressure monitoring and orthostatic maneuvers. However, using transcranial Doppler ultrasonography mean velocity changes as a surrogate for flow assumes static caliber of the vessel, and current vascular imaging modalities may be insensitive to detection of these small-caliber changes.Despite these limitations, this study complements and is consistent with previous studies regarding the cerebral hemodynamic affects of blood pressure lowering. Serrador et al,5 using similar techniques, demonstrated preserved autoregulation with orthostatic challenge (mean arterial pressure decrease: 21 to 25 mm Hg) in elderly subjects age 72±4 years with normotension (mean systolic blood pressure [SBP]: 125 mm Hg), controlled hypertension (SBP: 160 mm Hg at screening; mean SBP: 162 mm Hg). In addition, improved cerebral blood flow in elderly uncontrolled hypertensive subjects after 6 months of aggressive blood pressure control has been observed.6 Another study of patients with and those without clinically silent white matter ischemic lesions demonstrated similar vasomotor responses to acetazolamide challenge despite higher baseline pulsatility in those with white matter lesions, suggesting more resistant vessels.7Lastly, consideration must be given to the variable effects on cerebral blood flow of different antihypertensive agents. The cerebral circulation has angiotensin receptors that may account for the improved cerebral blood flow and favorable autoregulatory responses in studies of hypertensive subjects treated with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. α-Adrenergic innervation of cerebral resistance vessels may result in similar effects from α-antagonists. Calcium channel blockers have variable specificity for cerebral vessels, and studies of β-blockers have shown either no effect on cerebral blood flow or a slight decrease.8,9Clearly, long-term blood pressure control is effective for vascular disease prevention, and normal blood pressure should be the treatment goal for most patients.4 Rapid blood pressure normalization is generally well tolerated for most patients with mild and moderate hypertension. The report of Zhang et al3 and other studies enhance our understanding of the physiological impact of blood pressure lowering in these groups. Hopefully, ongoing and future studies will clarify treatment strategies for special populations, such as those with cerebrovascular disease, severe hypertension, and cognitive impairment.The opinions expressed in this editorial are not necessarily those of the editors or of the American Heart Association.DisclosuresS.R. has received a speaker honoraria from VasSol, Inc, Genentech, and Boehringer Ingelheim; is a consultant at Novartis; and has received compensation for expert witness testimony for various legal firms. V.A. reports no conflicts.FootnotesCorrespondence to Sean Ruland, Department of Neurology and Rehabilitation, University of Illinois College of Medicine, 912 S Wood St, Room 855N (mailcode 796), Chicago, IL 60612. E-mail [email protected] References 1 Faraci FM, Heistad DD. Regulation of the cerebral circulation: role of endothelium and potassium channels. Physiol Rev. 1998; 78: 53–97.CrossrefMedlineGoogle Scholar2 Immink RV, van den Born BH, van Montfrans GA, Koopmans RP, Karemaker JM, van Lieshout JJ. Impaired cerebral autoregulation in patients with malignant hypertension. Circulation. 2004; 110: 2241–2245.LinkGoogle Scholar3 Zhang R, Witkowski S, Fu Q, Claasen JAHR, Levine BD. Cerebral hemodynamics after short- and long-term reduction in blood pressure in mild and moderate hypertension. Hypertension. 2007; 49: 1149–1155.LinkGoogle Scholar4 Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Isso JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Rocella EJ and the National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003; 42: 1206–1252.LinkGoogle Scholar5 Serrador JM, Sorond FA, Vyas M, Gagnon M, Iluputaife ID, Lipsitz LA. Cerebral pressure-flow relations in hypertensive elderly humans: transfer gain in different frequency domains. J Appl Physiol. 2004; 98: 151–159.MedlineGoogle Scholar6 Lipsitz LA, Gagnon M, Vyas M, Iloputaife I, Kiely DK, Sorond F, Serrador J, Cheng DM, Babikian V, Cupples LA. Antihypertensive therapy increases cerebral blood flow and carotid distensibility in hypertensive elderly subjects. Hypertension. 2005; 45: 216–221.LinkGoogle Scholar7 Sierra C, de la Sierra A, Chamorro A, Larrousse M, Domenech M, Coca A. Cerebral hemodynamics and silent cerebral white matter lesions in middle-aged essential hypertensive patients. Blood Press. 2004; 13: 304–309.CrossrefMedlineGoogle Scholar8 Strandgaard S, Paulson OB. Regulation of cerebral blood flow in health and disease. J Cardiovasc Pharm. 1992; 19: S89–S93.CrossrefMedlineGoogle Scholar9 James IM, Yogendran L, McLaughlin K, Munro C. Blood pressure lowering and cerebral blood flow: a comparison of the effects of Carvedilol and Propranolol on the cerebral circulation in hypertensive patients. J Cardiovasc Pharm. 1992; 19: S40–S43.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited ByRaber I, Belanger M, Farahmand R, Aggarwal R, Chiu N, Al Rifai M, Jacobsen A, Lipsitz L and Juraschek S (2022) Orthostatic Hypotension in Hypertensive Adults: Harry Goldblatt Award for Early Career Investigators 2021, Hypertension, 79:11, (2388-2396), Online publication date: 1-Nov-2022. Bozkurt S, Volkan Yilmaz A, Bakaya K, Bharadwaj A and Safak K (2022) A novel computational model for cerebral blood flow rate control mechanisms to evaluate physiological cases, Biomedical Signal Processing and Control, 10.1016/j.bspc.2022.103851, 78, (103851), Online publication date: 1-Sep-2022. Gonzalez-Marrero I, Hernández-Abad L, Castañeyra-Ruiz L, Carmona-Calero E and Castañeyra-Perdomo A (2022) Changes in the choroid plexuses and brain barriers associated with high blood pressure and ageing, Neurología (English Edition), 10.1016/j.nrleng.2020.05.007, 37:5, (371-382), Online publication date: 1-Jun-2022. Gonzalez-Marrero I, Hernández-Abad L, Castañeyra-Ruiz L, Carmona-Calero E and Castañeyra-Perdomo A (2022) Variaciones de los plexos coroideos y las barreras cerebrales en la hipertensión arterial y el envejecimiento, Neurología, 10.1016/j.nrl.2018.06.001, 37:5, (371-382), Online publication date: 1-Jun-2022. Almeida J, Seixas F, Mexedo C and Machado H Cerebral Autoregulation in Unilateral Carotid Agenesis: How Low Can We Go?, Cureus, 10.7759/cureus.24232 Dolui S, Detre J, Gaussoin S, Herrick J, Wang D, Tamura M, Cho M, Haley W, Launer L, Punzi H, Rastogi A, Still C, Weiner D, Wright J, Williamson J, Wright C, Bryan R, Bress A, Pajewski N and Nasrallah I (2022) Association of Intensive vs Standard Blood Pressure Control With Cerebral Blood Flow, JAMA Neurology, 10.1001/jamaneurol.2022.0074, 79:4, (380), Online publication date: 1-Apr-2022. Antony J, Singh G, Yadav B, Abraham M and George S (2021) Effect of Beach-Chair Position on Cerebral Blood Flow in Patients Undergoing Shoulder Surgery—A Preliminary Observational Study, Journal of Neuroanaesthesiology and Critical Care, 10.1055/s-0041-1732830, 09:01, (016-020), Online publication date: 1-Mar-2022. Aykanat V, Myles P, Weinberg L, Burrell A and Bellomo R (2021) Low-Concentration Norepinephrine Infusion for Major Surgery: A Safety and Feasibility Pilot Randomized Controlled Trial, Anesthesia & Analgesia, 10.1213/ANE.0000000000005811, 134:2, (410-418), Online publication date: 1-Feb-2022. Lau K, Baloi M, Dumitrascu‐Biris D, Nicolaides K and Kametas N (2022) Changes in ophthalmic artery Doppler during acute blood‐pressure control in hypertensive pregnant women, Ultrasound in Obstetrics & Gynecology, 10.1002/uog.23755, 59:2, (185-191), Online publication date: 1-Feb-2022. Cohen B, Rivas E, Yang D, Mascha E, Ahuja S, Turan A and Sessler D (2022) Intraoperative Hypotension and Myocardial Injury After Noncardiac Surgery in Adults With or Without Chronic Hypertension: A Retrospective Cohort Analysis, Anesthesia & Analgesia, 10.1213/ANE.0000000000005922, Publish Ahead of Print Nair T (2022) Hypertensive Urgency and Emergency: Diagnostic and Therapeutic Considerations Hypertension and Cardiovascular Disease in Asia, 10.1007/978-3-030-95734-6_26, (367-380), . Vynckier J, Maamari B, Grunder L, Goeldlin M, Meinel T, Kaesmacher J, Hakim A, Arnold M, Gralla J, Seiffge D and Fischer U (2021) Early Neurologic Deterioration in Lacunar Stroke, Neurology, 10.1212/WNL.0000000000012661, 97:14, (e1437-e1446), Online publication date: 5-Oct-2021. Krittayaphong R, Pumprueg S, Ratanasumawong K, Sairat P and Lip G (2021) Average Systolic Blood Pressure and Clinical Outcomes in Patients with Atrial Fibrillation: Prospective Data from COOL-AF Registry, Clinical Interventions in Aging, 10.2147/CIA.S335321, Volume 16, (1835-1846) Landman T, Thijssen D, Tuladhar A and de Leeuw F (2021) Relation between physical activity and cerebral small vessel disease: A nine-year prospective cohort study, International Journal of Stroke, 10.1177/1747493020984090, 16:8, (962-971), Online publication date: 1-Oct-2021. Smith E, Pizzey F, Askew C, Mielke G, Ainslie P, Coombes J and Bailey T (2021) Effects of cardiorespiratory fitness and exercise training on cerebrovascular blood flow and reactivity: a systematic review with meta-analyses, American Journal of Physiology-Heart and Circulatory Physiology, 10.1152/ajpheart.00880.2020, 321:1, (H59-H76), Online publication date: 1-Jul-2021. Minhas J, Wang X, Lindley R, Delcourt C, Song L, Woodward M, Lee T, Broderick J, Pontes-Neto O, Kim J, Ricci S, Lavados P, Bath P, Durham A, Wang J, Sharma V, Demchuk A, Martins S, Chalmers J, Anderson C and Robinson T (2020) Comparative effects of intensive-blood pressure versus standard-blood pressure-lowering treatment in patients with severe ischemic stroke in the ENCHANTED trial, Journal of Hypertension, 10.1097/HJH.0000000000002640, 39:2, (280-285), Online publication date: 1-Feb-2021. Garton A, Gupta V, Giantini Larsen A, Kamel H, Knopman J and Stieg P (2020) Letter, Neurosurgery, 10.1093/neuros/nyaa230, 87:3, (E428-E429), Online publication date: 1-Sep-2020. Cho S, Geocadin R, Caturegli G, Chan V, White B, Dodd-o J, Kim B, Sussman M, Choi C, Whitman G and Chen L (2020) Understanding Characteristics of Acute Brain Injury in Adult Extracorporeal Membrane Oxygenation: An Autopsy Study*, Critical Care Medicine, 10.1097/CCM.0000000000004289, 48:6, (e532-e536), Online publication date: 1-Jun-2020. Kim J, Lee S, Suh S, Bae J, Han J, Byun S, Han J, Kim J and Kim K (2020) Association of Low Blood Pressure with White Matter Hyperintensities in Elderly Individuals with Controlled Hypertension, Journal of Stroke, 10.5853/jos.2019.01844, 22:1, (99-107), Online publication date: 31-Jan-2020. Al-Abed M, Al-Bashir A, Al-Rawashdeh A, Alex R, Zhang R, Watenpaugh D and Behbehani K (2019) Estimation of cerebral blood flow velocity during breath-hold challenge using artificial neural networks, Computers in Biology and Medicine, 10.1016/j.compbiomed.2019.103508, 115, (103508), Online publication date: 1-Dec-2019. Kim J, Yoon H, Lee H, Park H, Park C, Dho Y and Hwang J (2019) Preoperative 5-aminolevulinic acid administration for brain tumor surgery is associated with an increase in postoperative liver enzymes: a retrospective cohort study, Acta Neurochirurgica, 10.1007/s00701-019-04053-6, 161:11, (2289-2298), Online publication date: 1-Nov-2019. Hadjadj L, Pál É, Monori-Kiss A, Sziva R, Korsós-Novák Á, Mária Horváth E, Benkő R, Magyar A, Magyar P, Benyó Z, Nádasy G and Várbíró S (2019) Vitamin D deficiency and androgen excess result eutrophic remodeling and reduced myogenic adaptation in small cerebral arterioles in female rats, Gynecological Endocrinology, 10.1080/09513590.2018.1554037, 35:6, (529-534), Online publication date: 3-Jun-2019. Howell S (2019) Consensus statements and expert guidance: interpret with care, British Journal of Anaesthesia, 10.1016/j.bja.2019.03.013, 122:6, (719-722), Online publication date: 1-Jun-2019. Miller J, Calo S, Reed B, Thompson R, Nahab B, Wu E, Chaudhry K and Levy P (2019) Cerebrovascular risks with rapid blood pressure lowering in the absence of hypertensive emergency, The American Journal of Emergency Medicine, 10.1016/j.ajem.2018.08.052, 37:6, (1073-1077), Online publication date: 1-Jun-2019. Lamperti M, Jain A and Dharmalingam S (2019) Neuroanesthesia and Coexisting Cardiac Problems: Acquired Co-existing Diseases and Neuroanesthesia, 10.1007/978-981-13-2086-6_4, (37-62), . Witcher P (2018) Preeclampsia: Acute Complications and Management Priorities, AACN Advanced Critical Care, 10.4037/aacnacc2018710, 29:3, (316-326), Online publication date: 15-Sep-2018. Liu H, Hartung E, Jawad A, Ware J, Laney N, Port A, Gur R, Hooper S, Radcliffe J, Furth S and Detre J (2018) Regional Cerebral Blood Flow in Children and Young Adults with Chronic Kidney Disease, Radiology, 10.1148/radiol.2018171339, 288:3, (849-858), Online publication date: 1-Sep-2018. Nguyen D, Huyghens L, Parra J, Schiettecatte J, Smitz J, Vincent J and Lazzeri C (2018) Hypotension and a positive fluid balance are associated with delirium in patients with shock, PLOS ONE, 10.1371/journal.pone.0200495, 13:8, (e0200495) Park C, Park J, Kim Y, Yoon Y, Lee S, Kim H, Kim Y, Cho G, Sohn D and Lee S (2018) Left Ventricular Geometry Determines Prognosis and Reverse J-Shaped Relation Between Blood Pressure and Mortality in Ischemic Stroke Patients, JACC: Cardiovascular Imaging, 10.1016/j.jcmg.2017.02.015, 11:3, (373-382), Online publication date: 1-Mar-2018. Howell S (2018) Preoperative Hypertension, Current Anesthesiology Reports, 10.1007/s40140-018-0248-7, 8:1, (25-31), Online publication date: 1-Mar-2018. DeMott J, Patel G and Lat I (2017) Effects of Chronic Antihypertensives on Vasopressor Dosing in Septic Shock, Annals of Pharmacotherapy, 10.1177/1060028017726552, 52:1, (40-47), Online publication date: 1-Jan-2018. DellaVolpe J, Kim M, Bleck T and Al-Khafaji A (2018) Cerebrovascular Physiology in Liver Disease Hepatic Critical Care, 10.1007/978-3-319-66432-3_6, (59-71), . Sato S and Anderson C (2018) Central Nervous System Disorders: Transient Ischemic Attack and Stroke (Ischemic/Hemorrhagic) Disorders of Blood Pressure Regulation, 10.1007/978-3-319-59918-2_20, (307-321), . Sweitzer B and Howell S (2017) The Goldilocks principle as it applies to perioperative blood pressure: what is too high, too low, or just right?, British Journal of Anaesthesia, 10.1093/bja/aex159, 119:1, (7-10), Online publication date: 1-Jul-2017. Kang M, Yang J, Lee Y, Park K, Park H, Shin D, Sung Y, Lee H and Shin D (2017) The role of phenylephrine in patients with small deep subcortical infarct and progressive weakness, Journal of the Neurological Sciences, 10.1016/j.jns.2017.04.008, 377, (107-111), Online publication date: 1-Jun-2017. Miller J, Merck L, Wira C, Meurer W, Schrock J, Nomura J, Siket M, Madsen T, Wright D, Panagos P and Lewandowski C (2017) The Advanced Reperfusion Era: Implications for Emergency Systems of Ischemic Stroke Care, Annals of Emergency Medicine, 10.1016/j.annemergmed.2016.06.042, 69:2, (192-201), Online publication date: 1-Feb-2017. Sabayan B, van Buchem M, Sigurdsson S, Zhang Q, Meirelles O, Harris T, Gudnason V, Arai A and Launer L (2016) Cardiac and Carotid Markers Link With Accelerated Brain Atrophy, Arteriosclerosis, Thrombosis, and Vascular Biology, 36:11, (2246-2251), Online publication date: 1-Nov-2016. Zheng D, Sato S, Arima H, Heeley E, Delcourt C, Cao Y, Chalmers J, Anderson C, Anderson C, Chalmers J, Arima H, Davis S, Heeley E, Huang Y, Lavados P, Neal B, Parsons M, Lindley R, Morgenstern L, Robinson T, Stapf C, Tzourio C, Wang J, Huang Y, Chen S, Chen X, Cui L, Liu Z, Lu C, Wang J, Wu S, Xu E, Yang Q, Zhang C, Zhang J, Beer R, Schmutzhard E, Redondo P, Kaste M, Soinne L, Tatlisumak T, Stapf C, Wartenberg K, Ricci S, Klijn K, Azevedo E, Chamorro A, Arnold M, Fischer U, Kaul S, Pandian J, Boyini H, Singh S, Rabinstein A, Estol C, Silva G, Lavados P, Olavarria V, Robinson T, Simes R, Bousser M, Hankey G, Jamrozik K, Johnston S, Li S, Heeley E, Anderson C, Bailey K, Chalmers J, Cheung T, Delcourt C, Chintapatla S, Ducasse E, Erho T, Hata J, Holder B, Knight E, Lindley R, Leroux M, Sassé T, Odgers E, Walsh R, Wolfowicz Z, Anderson C, Chen G, Delcourt C, Fuentes S, Lindley R, Peng B, Schneble H, Wang M, Arima H, Billot L, Heritier S, Li Q, Woodward M, Delcourt C, Abimbola S, Anderson S, Chan E, Cheng G, Chmielnik P, Hata J, Leighton S, Liu J, Rasmussen B, Saxena A, Tripathy S, Armenis M, Baig M, Naidu B, Starzec G, Steley S, Anderson C, Heeley E, Leroux M, Delcourt C, Sassé T, Knight E, Bailey K, Cheung T, Odgers E, Ducasse E, Holder B, Wolfowicz Z, Walsh R, Chintapatla S, Erho T, Estol C, Moles A, Ruiz A, Zimmermann M, Marinho J, Alves S, Angelim R, Araujo J, Kawakami L, Lavados P, Olavarria V, Bustos C, Gonzalez F, Munoz Venturelli P, Huang Y, Chen X, Huang Y, Jia R, Li N, Qu S, Shu Y, Song A, Sun J, Xiao J, Zhao Y, Wang J, Huang Q, Stapf C, Vicaut E, Chamam A, Viaud M, Dert C, Fiedler U, Jovis V, Kabla S, Marchand S, Pena A, Rochaud V, Mallikarjuna K, Boyini H, Hasan N, Berge E, Sandset E, Forårsveen A, Robinson T, Richardson D, Kumar T, Lewin S, Poulter N, Field J, Anjum A, Wilson A, Perelmuter H, Agarie A, Barboza A, Recchia L, Miranda I, Rauek S, Duplessis R, Dewey H, Walker L, Petrolo S, Bladin C, Sturm J, Crimmins D, Griffiths D, Schutz A, Zenteno V, Parsons M, Miteff F, Spratt N, Kerr E, Levi C, Phan T, Ma H, Sanders L, Moran C, Wong K, Read S, Henderson R, Wong A, Hull R, Skinner G, Davis S, Hand P, Yan B, Tu H, Campbell B, Anderson C, Delcourt C, Blacker D, Wijeratne T, Pathirage M, Jasinararchchi M, Matkovic Z, Celestino S, Gruber F, Vosko M, Diabl E, Rathmaier S, Beer R, Schmutzhard E, Pfausler B, Helbok R, Fazekas F, Fischer R, Poltrum B, Zechner B, Trummer U, Rutgers M, Peeters A, Dusart A, Duray M, Parmentier C, Ferrao-Santos S, Brouns R, De Raedt S, De Smedt A, VanHooff R, De Keyser J, Martins S, de Almeida A, Broudani R, Titton N, de Freitas G, Cardoso F, Giesel L, Lima N, Ferraz de Almeida A, Gomes R, Borges dos Santos T, Veloso Soares E, Neto O, Silva G, Gomes D, de Carvalho F, Miranda M, Marques A, Zétola V, de Matia G, Lange M, Montes J, Reccius A, Munoz Venturelli P, Olavarria V, Soto A, Rivas R, Klapp C, Illanes S, Aguilera C, Castro A, Figueroa C, Benavides J, Salamanca P, Concha M, Pajarito J, Araya P, Guerra F, Li Y, Liu G, Wang B, Zhang J, Chong Y, He M, Wang L, Liu J, Zhang X, Lai C, Jiang H, Yang Q, Cui S, Tao Q, Zhang Y, Yao S, Xu M, Zhang Y, Liu Z, Xiao H, Hu J, Tang J, Sun J, Ji H, Jiang M, Yu F, Zhang Y, Yang X, Guo X, Wang Y, Wu L, Liu Z, Gao Y, Sun D, Huang X, Wang Y, Liu L, Li Y, Li P, Jiang Y, Li H, Lu H, Zhou J, Yuan C, Qi X, Qiu F, Qian H, Wang W, Liu J, Huang Y, Sun W, Li F, Liu R, Peng Q, Ren Z, Fan C, Zhang Y, Wang H, Wang T, Shi F, Duan C, Chen S, Wang J, Chen Z, Tan X, Zhao Z, Gao Y, Chen J, Han T, Wu S, Zhang L, Wang L, Hu Q, Hou Q, Zhao X, Wang L, Zeng G, Ma L, Wang F, Chen S, Zeng L, Guo Z, Fu Y, Song Y, Tai L, Liu X, Su X, Yang Y, Dong R, Xu Y, Tian S, Cheng S, Su L, Xie X, Xu T, Geng D, Yan X, Fan H, Zhao N, Wang S, Yang J, Zhang J, Yan M, Li L, Li Z, Xu X, Wang F, Wu L, Guo X, Lian Y, Sun H, Liu D, Wang N, Tang Q, Han Z, Feng L, Cui Y, Tian J, Chang H, Sun X, Wang J, Liu C, Wen Z, Xu E, Lin Q, Zhang X, Sun L, Hu B, Zou M, Bao Q, Lin X, Zhao L, Tian X, Wang H, Wang X, Li X, Hao L, Duan Y, Wang R, Wei Z, Liu J, Ren S, Ren H, Wang Y, Dong Y, Cheng Y, Zou M, Liu W, Han J, Zhang C, Zhang Z, Zhu J, Wang Y, Li Q, Qian J, Sun Y, Liu K, Long F, Peng X, Zhang Q, Yuan Z, Wang C, Huang M, Zhang J, Wang F, He P, You Y, Wang X, Yang Q, Wang H, Xia J, Zhou L, Hou Y, Wang Y, Liu L, Qi Y, Mei L, Lu R, Chen G, Liu L, Ping L, Liu W, Zhou S, Wang J, Wang L, Li H, Zhang S, Wang L, Zou R, Guo J, Li M, Wei W, Soinne L, Curtze S, Saarela M, Strbian D, Scheperjans F, De Broucker T, Henry C, Cumurciuc R, Ibos-Augé N, Zéghoudi A, Pico F, Dereeper O, Simian M, Boisselier C, Mahfoud A, Timsit S, Merrien F, Guillon B, Sevin M, Herisson F, Magne C, Ameri A, Cret C, Stefanizzi S, Klapzcynski F, Denier C, Sarov-Riviere M, Stapf C, Reiner P, Mawet J, Hervé D, Buffon F, Touzé E, Domigo V, Lamy C, Calvet D, Pasquini M, Alamowitch S, Favrole P, Muresan I, Crozier S, Rosso C, Pires C, Leger A, Deltour S, Cordonnier C, Henon H, Rossi C, Zuber M, Bruandet M, Tamazyan R, Join-Lambert C, Juettler E, Krause T, Maul S, Endres M, Jungehulsing G, Hennerici M, Griebe M, Sauer T, Knoll K, Huber R, Knauer K, Knauer C, Raubold S, Schneider H, Hentschel H, Lautenschläger C, Schimmel E, Dzialowski I, Foerch C, Lorenz M, Singer O, Meyer dos Santos I, Hartmann A, Hamann A, Schacht A, Schrader B, Teíchmann A, Wartenberg K, Mueller T, Jander S, Gliem M, Boettcher C, Rosenkranz M, Beck C, Otto D, Thomalla G, Cheng B, Wong K, Leung T, Soo Y, Prabhakar S, Kesavarapu S, Gajjela P, Chenna R, Ummer K, Basheer M, Andipet A, Jagarlapudi M, Mohammed A, Pawar V, Eranki S, Pandian J, Singh Y, Akhtar N, Borah N, Ghose M, Choudhury N, Ichaporia N, Shendge J, Khese S, Pamidimukkala V, Inbamuthaiah P, Nuthakki S, Tagallamudi N, Gutti A, Khurana D, Kesavarapu P, Jogi V, Garg A, Samanta D, Sarma G, Nadig R, Mathew T, Anandan M, Caterbi E, Zini A, Cavazzuti M, Casoni F, Pentore R, Falzone F, Ricci S, Mazzoli T, Greco L, Menichetti C, Coppola F, Cenciarelli S, Gallinella E, Mattioni A, Condurso R, Sicilia I, Zampolini M, Corea F, Barbi M, Proietti C, Toni D, Pieroni A, Anzini A, Falcou A, Demichele M, Klijn C, Tveiten A, Thortveit E, Pettersen S, Holand N, Hitland B, Johnsen S, Eltoft A, Wasay M, Kamal A, Iqrar A, Ali L, Begum D, Gama G, Azevedo E, Fonseca L, Moreira G, Veloso L, Pinheiro D, Paredes L, Rozeira C, Gregorio T, Segura Martin T, Ayo O, Garcia-Garcia J, Feria Vilar I, Gómez Fernández I, Chamorro A, Amaro S, Urra X, Obach V, Cervera A, Silva Y, Serena J, Castellanos M, Terceno M, Van Eendenburg C, Fischer U, Arnold M, Weck A, Findling O, Lüdi R, Warburton E, Day D, Butler N, Bumanlag E, Caine S, Steele A, Osborn M, Dodd E, Murphy P, Esisi B, Brown E, Hayman R, Baliga V, Minphone M, Kennedy J, Reckless I, Pope G, Teal R, Michael K, Manawadu D, Kalra L, Lewis R, Mistry B, Cattermole E, Hassan A, Mandizvidza L, Bamford J, Brooks H, Bedford C, Whiting R, Baines P, Hussain M, Harvey M, Fotherby K, McBride S, Bourke P, Morgan D, Jennings-Preece K, Price C, Huntley S, Riddell V, Storey G, Lakey R, Subramanian G, Jenkinson D, Kwan J, David O, Tiwari D, James M, Keenan S, Eastwood H, Shaw L, Kaye P, Button D, Madigan B, Williamson D, Dixit A, Davis J, Hossain M, Ford G, Parry-Jones A, O'Loughlin V, Jarapa R, Naing Z, Lovelock C, O'Reilly J, Khan U, Bhalla A, Rudd A, Birns J, Werring D, Law R, Perry R, Jones I, Erande R, Roffe C, Natarajan I, Ahmad N, Finney K, Lucas J, Mistri A, Eveson D, Marsh R, Haunton V, Robinson T, Rabinstein A, Fugate J and Lepore S (2016) Estimated GFR and the Effect of Intensive Blood Pressure Lowering After Acute Intracerebral Hemorrhage, American Journal of Kidney Diseases, 10.1053/j.ajkd.2016.01.020, 68:1, (94-102), Online publication date: 1-Jul-2016. Hermida R and Ayala D (2016) Presión arterial ambulatoria, cronoterapia de la hipertensión y glaucoma, Medicina Clínica, 10.1016/j.medcli.2015.05.013, 146:1, (30-34), Online publication date: 1-Jan-2016. Hermida R and Ayala D (2016) Ambulatory blood pressure, chronotherapy of hypertension and glaucoma, Medicina Clínica (English Edition), 10.1016/j.medcle.2016.04.043, 146:1, (30-34), Online publication date: 1-Jan-2016. Sato S, Carcel C and Anderson C (2015) Blood Pressure Management After Intracerebral Hemorrhage, Current Treatment Options in Neurology, 10.1007/s11940-015-0382-1, 17:12, Online publication date: 1-Dec-2015. Castilla-Guerra L and Fernandez-Moreno M (2015) Antihypertensive Treatment After Ischemic Stroke in Elderly Adults: Beware of Nocturnal Hypotension Episodes, Journal of the American Geriatrics Society, 10.1111/jgs.13686, 63:10, (2204-2205), Online publication date: 1-Oct-2015. Fahy P, Malone F, McCarthy E, McCarthy P, Thornton J, Brennan P, O'Hare A, Looby S, Sultan S, Hynes N and Morris L (2015) An In Vitro Evaluation of Emboli Trajectories Within a Three-Dimensional Physical Model of the Circle of Willis Under Cerebral Blood Flow Conditions, Annals of Biomedical Engineering, 10.1007/s10439-015-1250-6, 43:9, (2265-2278), Online publication date: 1-Sep-2015. Witcher P, Chez B and Baird S (2015) Multisystem Effects of Hypertensive Disorders of Pregnancy, Journal of Perinatal & Neonatal Nursing, 10.1097/JPN.0000000000000114, 29:3, (229-239), Online publication date: 1-Jul-2015. Ryan D, Kenny R, Christensen S, Meaney J, Fagan A and Harbison J (2015) Ischaemic stroke or TIA in older subjects associated with impaired dynamic blood pressure control in the absence of severe large artery stenosis, Age and Ageing, 10.1093/ageing/afv011, 44:4, (655-661), Online publication date: 1-Jul-2015., Online publication date: 1-Jul-2015. Pandit A (2015) Evidence base for secondary prevention – Antihypertensive therapy in cerebrovascular disease, Apollo Medicine, 10.1016/j.apme.2015.03.001, 12:2, (100-102), Online publication date: 1-Jun-2015. Cermakova P, Eriksdotter M, Lund L, Winblad B, Religa P and Religa D (2014) Heart failure and Alzheimer′s disease, Journal of Internal Medicine, 10.1111/joim.12287, 277:4, (406-425), Online publication date: 1-Apr-2015. Alosco M, Gunstad J, Xu X, Clark U, Labbe D, Riskin-Jones H, Terrero G, Schwarz N, Walsh E, Poppas A, Cohen R and Sweet L (2014) The impact of hypertension on cerebral perfusion and cortical thickness in older adults, Journal of the American Society of Hypertension, 10.1016/j.jash.2014.04.002, 8:8, (561-570), Online publication date: 1-Aug-2014. Alosco M, Brickman A, Spitznagel M, Griffith E, Narkhede A, Raz N, Cohen R, Sweet L, Hughes J, Rosneck J and Gunstad J (2013) Independent and interactive effects of blood pressure and cardiac function on brain volume and white matter hyperintensities in heart failure, Journal of the American Society of Hypertension, 10.1016/j.jash.2013.04.011, 7:5, (336-343), Online publication date: 1-Sep-2013. Alosco M, Brickman A, Spitznagel M, van Dulmen M, Raz N, Cohen R, Sweet L, Colbert L, Josephson R, Hughes J, Rosneck J and Gunstad J (2012) The independent association of hypertension with cognitive function among older adults with heart failure, Journal of the Neurological Sciences, 10.1016/j.jns.2012.09.019, 323:1-2, (216-220), Online publication date: 1-Dec-2012. McWilliams L (2012) Hypertensive Emergency Emergency Management in Neurocritical Care, 10.1002/9781118297162.ch1, (1-11), Online publication date: 11-May-2012. Lim T, Hong J, Lee J, Shin D, Choi J and Huh K (2011) Induced-hypertension in progressing lacunar infarction, Journal of the Neurological Sciences, 10.1016/j.jns.2011.06.009, 308:1-2, (72-76), Online publication date: 1-Sep-2011. Polesskaya O, Silva J, Sanfilippo C, Desrosiers T, Sun A, Shen J, Feng C, Polesskiy A, Deane R, Zlokovic B, Kasischke K and Dewhurst S (2011) Methamphetamine causes sustained depression in cerebral blood flow, Brain Research, 10.1016/j.brainres.2010.12.017, 1373, (91-100), Online publication date: 1-Feb-2011. Cheng R, Shang Y, Kameny D, Hayes D and Yu G (2010) Noninvasive Optical Evaluation of Cerebral Autoregulation in Patients with Obstructive Sleep Apnea Biomedical Optics, 10.1364/BIOMED.2010.JMA103, 978-1-55752-887-2, (JMA103) Casado Naranjo I and Ramírez Moreno J (2008) Hipertensión arterial y función cognitiva, Medicina Clínica, 10.1157/13119721, 130:14, (542-552), Online publication date: 1-Apr-2008. May 2007Vol 49, Issue 5 Advertisement Article InformationMetrics https://doi.org/10.1161/HYPERTENSIONAHA.107.087502PMID: 17353508 Originally publishedMarch 12, 2007 PDF download Advertisement SubjectsCerebrovascular Disease/StrokeEndothelium/Vascular Type/Nitric OxideHypertensionMetabolismUltrasound
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