Brainstem compression as a cause of neurogenic hypertension

Primary or essential hypertension affects more than 50 million Americans, more than 6 million of whom cannot achieve adequate control of their condition with medication. The current neurophysiologic literature indicates that some forms of primary hypertension may be secondary to compression of the left rostral ventrolateral medulla near the root entry zones of cranial nerves 9 and 10 by arteries or veins. Surgical brainstem decompression may alleviate this hypertension or make it medically controllable. This paper reviews the experimental, anatomic, and clinical literature that supports the neurogenic theory of hypertension.