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Brain Bioenergetics in Chronic Hypertension: Risk Factor for Acute Ischemic Stroke. Biochem Pharmacol 2022; 205:115260. [PMID: 36179931 DOI: 10.1016/j.bcp.2022.115260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022]
Abstract
Chronic hypertension is one of the key modifiable risk factors for acute ischemic stroke, also contributing to determine greater neurological deficits and worse functional outcome when an acute cerebrovascular event would occur. A tight relationship exists between cerebrovascular autoregulation, neuronal activity and brain bioenergetics. In chronic hypertension, progressive adaptations of these processes occur as an attempt to cope with the demanding necessity of brain functions, creating a new steady-state homeostatic condition. However, these adaptive modifications are insufficient to grant an adequate response to possible pathological perturbations of the established fragile hemodynamic and metabolic homeostasis. In this narrative review, we will discuss the main mechanisms by which alterations in brain bioenergetics and mitochondrial function in chronic hypertension could lead to increased risk of acute ischemic stroke, stressing the interconnections between hemodynamic factors (i.e. cerebral autoregulation and neurovascular coupling) and metabolic processes. Both experimental and clinical pieces of evidence will be discussed. Moreover, the potential role of mitochondrial dysfunction in determining, or at least sustaining, the pathogenesis and progression of chronic neurogenic hypertension will be considered. In the perspective of novel therapeutic strategies aiming at improving brain bioenergetics, we propose some determinant factors to consider in future studies focused on the cause-effect relationships between chronic hypertension and brain bioenergetic abnormalities (and vice versa), so to help translational research in this so-far unfilled gap.
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Machado MF, Muela HCS, Costa-Hong VA, Yassuda MS, Moraes NC, Memória CM, Bor-Seng-Shu E, Massaro AR, Nitrini R, Bortolotto LA, Nogueira RDC. Evaluation of cerebral autoregulation performance in patients with arterial hypertension on drug treatment. J Clin Hypertens (Greenwich) 2020; 22:2114-2120. [PMID: 32966689 DOI: 10.1111/jch.14052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Michel Ferreira Machado
- Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | | | | | - Monica Sanches Yassuda
- Gerontology, School of Arts, Sciences and Humanities, University of São Paulo Medical School, São Paulo, Brazil
| | - Natalia Cristina Moraes
- Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Claudia Maia Memória
- Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Edson Bor-Seng-Shu
- Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Ayrton Roberto Massaro
- Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Ricardo Nitrini
- Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Luiz Aparecido Bortolotto
- Instituto do Coração (Incor), University of São Paulo Medical School - Hypertension Unit, São Paulo, Brazil
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Tziomalos K, Giampatzis V, Bouziana SD, Spanou M, Papadopoulou M, Kazantzidou P, Kostaki S, Kouparanis A, Savopoulos C, Hatzitolios AI. Effects of different classes of antihypertensive agents on the outcome of acute ischemic stroke. J Clin Hypertens (Greenwich) 2015; 17:275-80. [PMID: 25765927 PMCID: PMC8031997 DOI: 10.1111/jch.12498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 11/23/2014] [Accepted: 11/25/2014] [Indexed: 11/29/2022]
Abstract
It is unclear whether antihypertensive treatment before stroke affects acute ischemic stroke severity and outcome. To evaluate this association, the authors studied 482 consecutive patients (age 78.8±6.7 years) admitted with acute ischemic stroke. Stroke severity was assessed at admission with the National Institutes of Health Stroke Scale (NIHSS). The outcome was assessed with rates of adverse outcome (modified Rankin scale at discharge ≥2). Independent predictors of severe stroke (NIHSS ≥16) were female sex and atrial fibrillation. Treatment with diuretics before stroke was associated with nonsevere stroke. At discharge, patients with adverse outcome were less likely to be treated before stroke with β-blockers or with diuretics. Independent predictors of adverse outcome were older age, higher NIHSS at admission, and history of ischemic stroke. Treatment with diuretics before stroke appears to be associated with less severe neurologic deficit in patients with acute ischemic stroke.
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Affiliation(s)
- Konstantinos Tziomalos
- First Propedeutic Department of Internal MedicineMedical SchoolAristotle University of ThessalonikiAHEPA HospitalThessalonikiGreece
| | - Vasilios Giampatzis
- First Propedeutic Department of Internal MedicineMedical SchoolAristotle University of ThessalonikiAHEPA HospitalThessalonikiGreece
| | - Stella D. Bouziana
- First Propedeutic Department of Internal MedicineMedical SchoolAristotle University of ThessalonikiAHEPA HospitalThessalonikiGreece
| | - Marianna Spanou
- First Propedeutic Department of Internal MedicineMedical SchoolAristotle University of ThessalonikiAHEPA HospitalThessalonikiGreece
| | - Maria Papadopoulou
- First Propedeutic Department of Internal MedicineMedical SchoolAristotle University of ThessalonikiAHEPA HospitalThessalonikiGreece
| | - Pavlina Kazantzidou
- First Propedeutic Department of Internal MedicineMedical SchoolAristotle University of ThessalonikiAHEPA HospitalThessalonikiGreece
| | - Stavroula Kostaki
- First Propedeutic Department of Internal MedicineMedical SchoolAristotle University of ThessalonikiAHEPA HospitalThessalonikiGreece
| | - Antonios Kouparanis
- First Propedeutic Department of Internal MedicineMedical SchoolAristotle University of ThessalonikiAHEPA HospitalThessalonikiGreece
| | - Christos Savopoulos
- First Propedeutic Department of Internal MedicineMedical SchoolAristotle University of ThessalonikiAHEPA HospitalThessalonikiGreece
| | - Apostolos I. Hatzitolios
- First Propedeutic Department of Internal MedicineMedical SchoolAristotle University of ThessalonikiAHEPA HospitalThessalonikiGreece
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Dynamic Autoregulatory Response After Aneurysmal Subarachnoid Hemorrhage and Its Relation to Angiographic Vasospasm and Clinical Outcome. Neurocrit Care 2015; 23:355-63. [DOI: 10.1007/s12028-014-0104-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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