The effects of hypertension on the nervous system

With 60 million Americans meeting criteria for either essential or secondary hypertension, elevated arterial pressures remain a major health problem. While efforts to find etiologies for essential hypertension continue, clinicians battle its effects on organ systems, including the nervous system. Hypertensive changes in the nervous system may be acute, chronic, or both. The intracerebral vasculature is commonly affected. Not infrequently, acute changes including hemorrhage, encephalopathy, and cerebral edema are superimposed on chronic changes of hyaline and fibrinoid arteriolosclerosis. Chronic vascular changes sacrifice vascular lumina. The resulting ischemia is responsible for cystic (lacunar) lesions and subcortical ischemic white matter lesions consistent with Binswanger's disease.