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(Stroke. 2002;33:1180.)
© 2002 American Heart Association, Inc.

Letters to the Editor

Cerebral Atherosclerosis Causes Neurogenic Hypertension

Hernando Rafael, MD

Hospital Santa Teresa Zacatecas, Mexico City, Mexico

To the Editor:

Su et al¹ presented an excellent report regarding "the hypothesis that hypertension has a major role in the pathogenesis of atherosclerosis." The results of their study were very similar to other findings previously reported.² Both groups defended that essential arterial hypertension (EAH) is the major risk factor in the development of atherosclerosis. However, I offer some opposing comments upheld by many authors, based on clinical and neurosurgical evidences. First, EAH represents 90% to 95% of all cases of hypertension and is the main factor of risk in the generation of cerebrovascular and cardiovascular diseases. Second, generally there is a close correlation between age (about 35 years) and the incidence of essential hypertension³ as well as the onset of cerebral atherosclerosis.^4,5 Third, 5 areas are associated with EAH^6,7: denervation of the baroreceptors from the carotid sinus and aortic arc by atherosclerosis, and ischemia in the posterior hypothalamus and medulla oblongata (A₁/C₁ cell column, commissural portion of the nucleus solitarius, and A₂/C₂ cell column). Fourth, microvascular decompression of the left rostral ventrolateral medulla⁸ or the omental transplantation on the anterior perforated space^6,9 can improve or normalize EAH—by restitution of the blood flow in the A₁/C₁ cell column using the first surgical technique, and because of revascularization in the lateral and posterior hypothalamus produced with the last technique. Therefore, ischemia in the posterior hypothalamus and nuclei of the medulla oblongata are the specific causes of neurogenic hypertension.

Based on the above-mentioned factors and the efficacy of both neurosurgical techniques . . . [Full Text of this Article]

Yuan-Teh Lee, MD, PhD Ta-Chen Su, MD

Department of Internal Medicine, National Taiwan University Hospital

Jiann-Shing Jeng, MD

Department of Neurology, National Taiwan University Hospital

Fung-Chang Sung, PhD, MPH

College of Public Health, National Taiwan University, Taipei, Taiwan

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