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. 2017 Aug;39(4):359-372.
doi: 10.1007/s11357-017-9991-9. Epub 2017 Aug 29.

Hypertension impairs neurovascular coupling and promotes microvascular injury: role in exacerbation of Alzheimer's disease

Anna Csiszar  1   2 , Stefano Tarantini  1   2 , Gábor A Fülöp  1   2   3 , Tamas Kiss  1   2 , M Noa Valcarcel-Ares  1   2 , Veronica Galvan  4 , Zoltan Ungvari  1   2 , Andriy Yabluchanskiy  5   6
Affiliations

Hypertension impairs neurovascular coupling and promotes microvascular injury: role in exacerbation of Alzheimer's disease

Anna Csiszar et al. Geroscience. 2017 Aug.

Abstract

Hypertension in the elderly substantially increases both the risk of vascular cognitive impairment (VCI) and Alzheimer's disease (AD); however, the underlying mechanisms are not completely understood. This review discusses the effects of hypertension on structural and functional integrity of cerebral microcirculation, including hypertension-induced alterations in neurovascular coupling responses, cellular and molecular mechanisms involved in microvascular damage (capillary rarefaction, blood-brain barrier disruption), and the genesis of cerebral microhemorrhages and their potential role in exacerbation of cognitive decline associated with AD. Understanding and targeting the hypertension-induced cerebromicrovascular alterations that are involved in the onset and progression of AD and contribute to cognitive impairment are expected to have a major role in preserving brain health in high-risk older individuals.

Keywords: Alzheimer’s disease; Angiotensin II; Endothelial dysfunction; Functional hyperemia; High blood pressure; Hypertension; Microcirculation; Neurovascular coupling; VCID.

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Figures

Fig. 1
Fig. 1
Cerebromicrovascular alterations by which hypertension promotes the pathogenesis of vascular cognitive impairment and AD. Hypertension promotes microvascular oxidative stress and microvascular injury, which are exacerbated in aging (Girouard et al. ; Toth et al. , ; Springo et al. 2015b). In patients with AD pathologies, hypertension increases the deposition of Aβ and exacerbates cerebromicrovascular dysfunction induced by Aβ. Microvascular injury, aggravated by structural and functional microvascular maladaptation to hypertension, leads to blood-brain barrier disruption promoting neuroinflammation, microhemorrhages, and microvascular rarefaction. Hypertension-induced, oxidative stress-mediated neurovascular uncoupling further compromises the blood supply to the brain. The model predicts that these hypertension-induced structural and functional microvascular alterations critically contribute to cognitive decline in high-risk elderly patients
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