HYPERTENSIVE CEREBROVASCULAR-DISEASE AND THE RENIN-ANGIOTENSIN SYSTEM

Background Arterial hypertension is the leading cause of cardiovascula r disease and is associated with an increased risk of stroke and heart attack. These complications have been largely attributed to the remod eling of the arterial wall, including accelerated atherosclerosis occu rring in hypertensive patients. Although the risk of haemorrhagic stro ke seems to be directly related to the level of blood pressure elevati on, no such tight relationship has been found between blood pressure l evels and atherosclerosis. This observation has led to the concept tha t a number of genetic, humoral, and cellular factors may be involved i n atherogenesis in hypertensive patients. Summary of Review The experi mental and clinical evidence concerning the role of the renin-angioten sin system in cardiovascular remodeling and atherogenesis of the cereb rovascular bed as well as the data supporting an association between a ngiotensin II and thrombotic stroke are examined. Conclusions The cont ribution of the renin-angiotensin system to the pathogenesis of accele rated carotid artery atherosclerosis and particularly of cerebrovascul ar disease remains to be definitively proven. However, the bulk of exp erimental and clinical data are consistent with the hypothesis that th e renin-angiotensin system may play a detrimental role.