Neural mechanisms underlying blood pressure dynamics and cardiovascular control

Blood pressure regulation involves bidirectional brain-heart interactions mediated by both neurochemical signals and mechanosensitive pathways that include recently identified piezo receptors. We review current findings on the dynamic interplay between neural activity and blood pressure, highlighting insights from neuroimaging, systemic electrophysiology, and cellular biology. At a systemic level, blood pressure dynamics is regulated by coordinated oscillatory patterns across brain, cardiac, and respiratory signaling that couple with autonomic outflow and vascular pulsatility. Central autonomic networks, sympathetic-parasympathetic activity, and beat-to-beat blood pressure variability are mainly involved in such bidirectional interactions. At the cellular level, astrocytes, pericytes, endothelial cells, and cardiac and neural glia integrate mechanical pressure signals with metabolic and synaptic activity, forming distributed mechanosensory networks within the neurovascular unit and the cardiac autonomic nervous system. We show that optimal perfusion depends on arterial pressure remaining above a critical threshold to maintain vascular patency, with autoregulatory, metabolic, neurogenic, and glia-mediated mechanisms buffering systemic pressure fluctuations. When perfusion falls, astrocyte- and pericyte-dependent baroreflex mechanisms increase sympathetic drive, whereas pressure surges and altered arterial compliance promote vasoconstriction through coordinated neurovascular and central-autonomic responses. Pathological changes in arterial compliance and pulsatility, including loss of Windkessel function and nonphysiological flow states, distort neural pressure sensing and contribute to cardiovascular, cerebrovascular, and cognitive dysfunction and altered emotional processing. Invasive and noninvasive neuromodulation strategies may offer therapeutic potential by restoring physiological mechanosensory and autonomic control. These insights highlight the importance of mapping systemic central-autonomic networks and cell-specific neuromechanotransduction in health and in neurological, cardiovascular, and psychiatric disorders (1).