Abstract
There is growing evidence that hypertension is the most important vascular risk factor for the development and progression of cardiovascular and cerebrovascular diseases. The brain is an early target of hypertension-induced organ damage and may manifest as stroke, subclinical cerebrovascular abnormalities and cognitive decline. The pathophysiological mechanisms of these harmful effects remain to be completely clarified. Hypertension is well known to alter the structure and function of cerebral blood vessels not only through its haemodynamics effects but also for its relationships with endothelial dysfunction, oxidative stress and inflammation. In the last several years, new possible mechanisms have been suggested to recognize the molecular basis of these pathological events. Accordingly, this review summarizes the factors involved in hypertension-induced brain complications, such as haemodynamic factors, endothelial dysfunction and oxidative stress, inflammation and intervention of innate immune system, with particular regard to the role of Toll-like receptors that have to be considered dominant components of the innate immune system. The complete definition of their prognostic role in the development and progression of hypertensive brain damage will be of great help in the identification of new markers of vascular damage and the implementation of innovative targeted therapeutic strategies.
Highlights
There is growing evidence that hypertension is the most important vascular risk factor for the development and progression of cardiovascular and cerebrovascular diseases
The brain is an early target of hypertension-induced organ damage that can manifest itself either in the acute form such as thrombotic, embolic or haemorrhagic stroke or in the chronic form such as vascular dementia and cognitive impairment [1,2]
Hypertension-related small vessel disease can contribute to the occurrence of lacunar infarction, alterations of the white matter and intracerebral haemorrhagic events both to the development of vascular dementia and influence on Alzheimer’s pathology, lowering the threshold at which signs and symptoms occur
Summary
The brain is an early target of hypertension-induced organ damage that can manifest itself either in the acute form such as thrombotic, embolic or haemorrhagic stroke or in the chronic form such as vascular dementia and cognitive impairment [1,2]. There is growing evidence that hypertension represents the most important modifiable risk factor, after age, for haemorrhagic and ischemic stroke and cerebral small vessel disease (cSVD). Long-lasting hypertension can induce the development of cognitive impairment and dementia and influence its progression, even if both are dependent on old age. Several factors are able to increase the individual predisposition to the cerebrovascular consequences of arterial hypertension, so their identification is essentially better to define the relationship between blood pressure and brain functions. In assessing brain damage induced by arterial hypertension, particular importance has been given to certain characteristics of hypertension, such as blood pressure variability
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