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Hypertension and Stroke

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Hypertension and the Brain as an End-Organ Target

Abstract

Hypertension, the leading risk factor for disease globally, is a particular problem for people of African origin, who are more likely to have undiagnosed causes of hypertension due to genetic variants causing salt and water retention. High blood pressure causes damage to small resistance arteries at the base of the brain, in a territory called the “vascular centrencephalon,” that is the phylogenetically ancient part of the brain. Short straight arteries supplying the internal capsule, basal ganglia, thalamus, brainstem, and cerebellum are damaged directly by high pressure, causing fibrinoid necrosis and hyaline degeneration. These pathologies cause lacunar infarctions when the arterioles occlude, and intracerebral hemorrhage when they rupture. The cerebral hemorrhages are perfused by long arteries with many branches, acting like a step-down transformer, so infarctions and hemorrhages in the cortical regions of the hemispheres are not due to hypertension. Lobar hemorrhages are usually due to amyloid angiopathy. Controlling hypertension virtually eliminates hypertensive intracerebral hemorrhage and markedly reduces lacunar infarctions.

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Authors and Affiliations

  1. Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, Western University, 1400 Western Road, London, ON, Canada, N6G 2V4

    J. David Spence M.D., F.R.C.P.C., F.A.H.A. (Professor of Neurology and Clinical Pharmacology)

  2. Division of Neuropathology, Department of Pathology and Laboratory Medicine, Robarts Research Institute, Western University, London, ON, Canada

    J. David Spence M.D., F.R.C.P.C., F.A.H.A. (Professor of Neurology and Clinical Pharmacology) & Robert Hammond M.D., F.R.C.P.C.

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  1. J. David Spence M.D., F.R.C.P.C., F.A.H.A.
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  2. Robert Hammond M.D., F.R.C.P.C.
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Correspondence to J. David Spence M.D., F.R.C.P.C., F.A.H.A. .

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  1. Faculty of Medicine, Université de Montréal, Montréal, Canada

    Hélène Girouard

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Spence, J.D., Hammond, R. (2016). Hypertension and Stroke. In: Girouard, H. (eds) Hypertension and the Brain as an End-Organ Target. Springer, Cham. https://doi.org/10.1007/978-3-319-25616-0_3

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