Cerebral Haemodynamics: Effects of Systemic Arterial Pulsatile Function and Hypertension

Avolio, Alberto; Kim, Miok; Adji, Audrey; Gangoda, Sumudu V. S.; Avadhanam, Bhargava; Tan, Isabella; Butlin, Mark

doi:10.1007/s11906-018-0822-x

Cited by 53 publications

(34 citation statements)

References 96 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A recent study recently highlighted the impact of DBP on the cortical cerebral blood flow (36). As other lowresistance organs, the cerebral diastolic flow is crucial for the perfusion of the microvasculature (37). Recently, we also found an impact of DBP variability during EVT on functional outcome (31).…”

Section: Discussionsupporting

confidence: 51%

Impact of Blood Pressure After Successful Endovascular Therapy for Anterior Acute Ischemic Stroke: A Systematic Review

et al. 2020

View full text Add to dashboard Cite

Background and Purpose: Optimal blood pressure (BP) targets after endovascular therapy (EVT) for acute ischemic stroke (AIS) still need to be assessed, especially according to the recanalization status. Facing the lack of randomized controlled trials addressing this question, we performed a systematic review of studies assessing the post-EVT BP impact on functional outcome and symptomatic intracranial hemorrhage (sICH). Methods: Studies published after January 1, 2012 were included in the systematic review. The PRISMA checklist and flow diagram were followed for the design and reporting of this work. Results: Five studies were included in the present analysis. Despite a significant heterogeneity among studies which precluded a meta-analysis, systolic BP (SBP) was the most frequently used parameter to describe BP. BP variability (standard deviation, successive variability) after EVT was associated with worse functional outcome, especially in studies without specific BP targets after successful EVT. Lower BP values after successful EVT were associated with lower odds of sICH. Four studies evaluated the post-EVT BP impact on recanalized patients solely, with only one specifically addressing the impact of a TICI 2B vs. 2C. Interestingly, SBP reduction was inversely associated with worse outcomes in TICI 3 patients but not in TICI 2B patients, pointing to the potential value of BP management according to the exact TICI. Conclusions: BP post-EVT seems to be associated with worse functional outcomes and sICH. However, given the important heterogeneity depicted among the included studies, no decisive conclusion can be made from this systematic review, thus underlying the urgent need of randomized controlled trials evaluating this question.

show abstract

Section: Discussionsupporting

confidence: 51%

Impact of Blood Pressure After Successful Endovascular Therapy for Anterior Acute Ischemic Stroke: A Systematic Review

et al. 2020

View full text Add to dashboard Cite

show abstract

“…In healthy elastic arteries (thoracic aorta and common carotid artery), the compliance of these vessels dampens pressure and flow fluctuations, thereby allowing delivery of a steady flow of blood to the more vulnerable microcirculation (Chirinos et al, 2019). Sustained mechanical stress causes arteries to lose their distensibility, leading to increased stiffness (Avolio et al, 2018;Mitchell, 2018). Thus, both age and hypertension result in a reduction in pressure-buffering capacity upstream from the cerebral microcirculation.…”

Section: Vascular Stiffnessmentioning

confidence: 99%

Vasculo-Neuronal Coupling and Neurovascular Coupling at the Neurovascular Unit: Impact of Hypertension

et al. 2020

View full text Add to dashboard Cite

Components of the neurovascular unit (NVU) establish dynamic crosstalk that regulates cerebral blood flow and maintain brain homeostasis. Here, we describe accumulating evidence for cellular elements of the NVU contributing to critical physiological processes such as cerebral autoregulation, neurovascular coupling, and vasculoneuronal coupling. We discuss how alterations in the cellular mechanisms governing NVU homeostasis can lead to pathological changes in which vascular endothelial and smooth muscle cell, pericyte and astrocyte function may play a key role. Because hypertension is a modifiable risk factor for stroke and accelerated cognitive decline in aging, we focus on hypertension-associated changes on cerebral arteriole function and structure, and the molecular mechanisms through which these may contribute to cognitive decline. We gather recent emerging evidence concerning cognitive loss in hypertension and the link with vascular dementia and Alzheimer's disease. Collectively, we summarize how vascular dysfunction, chronic hypoperfusion, oxidative stress, and inflammatory processes can uncouple communication at the NVU impairing cerebral perfusion and contributing to neurodegeneration.

show abstract

“…Despite representing only 2% of the total body weight, the human brain at rest uses approximately 15%‐20% of the cardiac output, that is, the same blood volume as the skeletal muscles, which weight 20 times more 1 . Maintenance and restoration of ionic gradients, membrane potentials, and neurotransmission regulation are the main factors responsible for this high cerebral metabolic demand 2 .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of cerebral autoregulation performance in patients with arterial hypertension on drug treatment

Machado

Muela

Costa-Hong

et al. 2020

J of Clinical Hypertension

View full text Add to dashboard Cite

Cerebral autoregulation (AR) keeps cerebral blood flow constant despite fluctuations in systemic arterial pressure. The final common AR pathway is made up of vasomotor adjustments of cerebrovascular resistance mediated by arterioles. Structural and functional changes in the arteriolar wall arise with age and systemic arterial hypertension. This study evaluated whether AR is impaired in hypertensive patients and whether this impairment differs with disease control. Three groups of patients were prospectively compared: hypertensive patients under treatment with systolic blood pressure (SBP) <140 and diastolic blood pressure (DBP) <90 mm Hg (n = 54), hypertensive patients under treatment with SBP > 140 or DBP > 90 mm Hg (n = 31), and normotensive volunteers (n = 30). Simultaneous measurements of cerebral blood flow velocity (CBFV) and BP were obtained by digital plethysmography and transcranial Doppler, and the AR index (ARI) was defined according to the step response to spontaneous fluctuations in BP. Compared to the uncontrolled hypertension, the normotensive individuals were younger (age 43.42 ± 11.14, P < .05) and had a lower resistance‐area product (1.17 ± 0.24, P < .05), although age and greater arteriolar stiffness did not affect the CBFV mean of hypertensive patients, whether controlled or uncontrolled (62.85 × 58.49 × 58.30 cm/s, P = .29), most likely because their ARIs were not compromised (5.54 × 5.91 × 5.88, P = .6). Hypertensive patients under treatment, regardless of their BP control, have intact AR capacity.

show abstract

Cerebral Haemodynamics: Effects of Systemic Arterial Pulsatile Function and Hypertension

Cited by 53 publications

References 96 publications

Impact of Blood Pressure After Successful Endovascular Therapy for Anterior Acute Ischemic Stroke: A Systematic Review

Impact of Blood Pressure After Successful Endovascular Therapy for Anterior Acute Ischemic Stroke: A Systematic Review

Vasculo-Neuronal Coupling and Neurovascular Coupling at the Neurovascular Unit: Impact of Hypertension

Evaluation of cerebral autoregulation performance in patients with arterial hypertension on drug treatment

Contact Info

Product

Resources

About