Original articleIntracranial aneurysms and arterial hypertension: a review and hypothesis
Section snippets
Clinical studies
Only clinical series with more than 50 patients with aneurysms that also stated the incidence of premorbid (preexisting) hypertension were included in this study 13, 23, 34, 44, 46, 52, 53, 54, 57, 64, 73, 85, 87, 101, 109, 114.
In 1979, Andrews and Spiegel [2] examined the relationship between blood pressure and aneurysms in 212 unselected patients. Hypertension was not significantly more prevalent in patients with aneurysms than in an age-matched general control group. Juvela [44] and Ohman
Experimental studies
Experimental studies 36, 38, 39, 48, 51, 66, 97, 111 confirmed the findings of these clinical studies. Several authors demonstrated that hypertension and hemodynamic stress play an important role in the formation of aneurysms. For example, Hashimoto et al 38, 39 induced cerebral aneurysms in the presence of hypertension in rats and monkeys using carotid ligation and β-aminoproprionitrile, which is a lathyrogen. Lathyrogens cause connective tissue abnormalities and fragility. Nagata et al [67]
Autopsy studies
Only autopsy studies 3, 14, 19, 21, 70, 93, 116, 120 with more than 25 cases were included in this review. Although some autopsy studies failed to find an association between hypertension and aneurysm formation [63], most have documented a close correlation. In these autopsy studies, blood pressure was determined from the patient’s medical record preceding admission and/or myocardial (left ventricular) hypertrophy.
In 1954, Wilson et al [120] performed an autopsy study of patients with ruptured
A proposed hypothesis
Although definitive studies on the role of hypertension in aneurysmal formation are lacking, the combined data from clinical, experimental, and autopsy studies strongly suggest that systemic arterial hypertension is a more important risk factor in the development of intracranial aneurysms than previously suspected. However, what is the pathophysiological mechanism(s) underlying this increased incidence of aneurysmal formation associated with hypertension? We propose that three processes are
Conclusions
Chronic hypertension causes intimal thickening, medial necrosis, changes in the matrix composition, and degeneration of the internal elastic lamina to develop in the arterial wall. Weakening of the arterial wall by these structural changes would likely lead to focal dilatation and the initial bulging of the arterial walls. Eventually, an aneurysm would develop (Figure 1). Endothelial injury, degeneration of the internal elastic lamina, and thinning of the media smooth muscle cells are early
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