- Poster presentation
- Open Access
Insights from cardiovascular magnetic resonance imaging supporting the selfish brain hypothesis of arterial hypertension
© Rodrigues et al; licensee BioMed Central Ltd. 2015
- Published: 3 February 2015
- Cardiovascular Magnetic Resonance
- Leave Ventricular Mass
- Resistant Hypertension
- Cardiovascular Magnetic Resonance Imaging
- Posterior Cerebral Circulation
Brainstem hypoperfusion may evoke systemic hypertension as a mechanism to boost cerebral blood flow: the selfish brain hypothesis. This notion is supported by evidence of vertebral artery hypoplasia (VAH) in hypertensive rat models. We determined the prevalence of anatomical variations of posterior cerebral circulation which could predispose to brainstem hypoperfusion in a hypertensive human cohort.
One hundred and twenty one (n=121) MRAs were studied (mean age 51.7±14.5 vs controls: 62.±10.3 years, p>0.05). VAH was more prevalent in hypertensives than controls [EH1] (51.2% vs 26.5%, p<0.0001), with right-sided VAH [69.4% (n=43/62)] most common. There was a higher prevalence of incomplete posterior CoW in hypertensives (62.0% vs 38.0%, p<0.01). Of the posterior CoW variants, complete disconnection of anterior/posterior CoW was more common in hypertensives (30.6% vs 10.1%, p<0.0001). Prevalence of both VAH and incomplete posterior CoW was higher in hypertensives compared to expected prevalence for controls (38.0% vs 10.1%, p<0.0001).
Amongst the resistant hypertension subgroup, VAH and incomplete CoW was more common than normal configuration [62.2%, n=23/37 vs 35.7%, n=30/84, p<0.01]. No difference in posterior circulation configuration prevalence was seen in difficult to treat (p=0.2497) or drug-intolerant (p=0.4218) hypertension. VAH and incomplete CoW was less common in young-onset hypertension [5.4% (n=2/37) vs 29.8% (n=25/84), p<0.005]. No differences in SBP (p=0.5757), DBP (p=0.8076) or indexed LVM (p=0.1553) were demonstrated between hypertensive patients with or without VAH and incomplete CoW.
A significantly higher prevalence of posterior cerebral circulation anatomical variations, which could lead to increased vascular resistance, is demonstrated in hypertensives compared to controls. VAH and incomplete posterior CoW is most prevalent in resistant hypertensives. Our data support the selfish brain hypothesis of brainstem hypoperfusion as a driver of hypertension.
NIHR Cardiovascular Biomedical Research Unit, Bristol Heart Institute
JCLR: Clinical Society of Bath Postgraduate Research Bursary
ECH: BHF grant IBSRF FS/11/1/2840.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.