Cerebral microvascular dysfunction and clinical considerations of systemic arterial hypertension

Hypertension is one of the most commonly diagnosed conditions in the general population. In 2017, the American College of Cardiology and American Heart Association lowered the threshold for hypertension diagnosis from 140 mmHg to 130 mmHg for systolic blood pressures. These new guidelines have brought into question the true prevalence of hypertension and overall risk of hypertensive complications. While the cardiovascular effects of hypertension have been a long-held concern, there is a growing awareness for the need to understand the extracardiac concerns of hypertension. Specifically, the brain and nervous system are vulnerable extracardiac targets of hypertensive damage. Hypertension is a well-known risk factor for ischemic and more so hemorrhagic stroke as well as cerebral small vessel disease (cSVD) including vascular dementia. However, hypertension may also have association to less-known neurological presentations which themselves may also pose risk for stroke and cSVD. This includes obstructive sleep apnea, posterior reversible encephalopathy syndrome, and neurogenic hypertension. We aim to present an overview of the contemporary literature in regard to hypertension and clinical consideration as it applies to the cerebrovascular system.