Effects of an angiotensin-converting enzyme inhibitor and a beta-blocker on cerebral arteriolar dilatation in hypertensive rats.

We examined the effects of the angiotensin-converting enzyme inhibitor perindopril and the beta-blocker propranolol on dilator responses of cerebral arterioles in chronic hypertension. Dilator responses to acute hypotension were examined in untreated Wistar-Kyoto rats (WKY) and stroke-prone spontaneously hypertensive rats (SHRSP) that were untreated or treated for 3 months with a low (0.3 mg. kg(-1). day(-1)) or a high (2 mg. kg(-1). day(-1)) dose of perindopril or a dose of propranolol (250 mg. kg(-1). day(-1)) alone or in combination with the low dose of perindopril. Pressure (servo-null) and diameter were measured in cerebral arterioles during acute reductions in arterial pressure both before and during maximal dilatation (EDTA). The high dose of perindopril or the combination of propranolol and perindopril normalized cerebral arteriolar pressure (52+/-2 [mean+/-SEM], 49+/-2 mm Hg versus 50+/-2 mm Hg in WKY and 96+/-3 mm Hg in untreated SHRSP; P<0.05). In contrast, the low dose of perindopril or propranolol alone did not normalize arteriolar pressure (74+/-2 mm Hg and 58+/-3 mm Hg). Both the low and high doses of perindopril improved autoregulatory dilatation, maximal dilatation, and dilator reserve of cerebral arterioles in SHRSP, with the low dose of perindopril being almost as effective as the high dose of perindopril. Propranolol alone did not significantly improve dilator function of cerebral arterioles. Furthermore, dilator function of cerebral arterioles was not further improved by the addition of propranolol to the low dose of perindopril. These findings suggest that angiotensin-converting enzyme inhibitors, such as perindopril, may be more effective than propranolol in attenuating the impairment of cerebral autoregulatory vasodilatation, maximal dilatation, and dilator reserve during treatment of chronic hypertension.

Effects of angiotensin-converting enzyme inhibitors on cerebral vascular structure in chronic hypertension.

Chronic hypertension profoundly alters the function and structure of cerebral blood vessels. Cerebral arterioles undergo remodelling, with a reduction in external diameter and hypertrophy of the vessel wall and a paradoxical increase in distensibility. The primary aim of this review is to consider recent findings in relation to determinants of remodelling, hypertrophy, and altered distensibility and composition of cerebral blood vessels during chronic hypertension, with an emphasis on the renin-angiotensin system. In particular, we highlight studies designed to examine the hypothesis that the effects of angiotensin-converting enzyme (ACE) inhibitors on cerebral vascular structure in stroke-prone spontaneously hypertensive rats (spSHR) may be independent of their effects on reductions in arterial pressure. For example, treatment of spSHR with the ACE inhibitor perindopril attenuates remodelling of cerebral arterioles, even when given in a low dose that only partially normalizes systemic arterial pressure and does not prevent hypertrophy. In contrast, treatment of spSHR with propranolol does not prevent cerebral arteriolar remodelling, even when given in a dose that produces a larger decrease in blood pressure than is achieved with the low dose of perindopril. Results such as these suggest that remodelling of cerebral arterioles during chronic hypertension may be independent of increases in arterial pressure, and instead may depend primarily on increased activity of the renin-angiotensin system. Evidence is also reviewed that suggests that the renin-angiotensin system may not contribute significantly to hypertrophy of cerebral arterioles during chronic hypertension. Rather, hypertrophy appears to depend in large part on increases in arterial pressure and, in particular, its pulsatile component.

Effects of an angiotensin-converting enzyme inhibitor and a beta-blocker on cerebral arterioles in rats.

We examined the effects of an angiotensin-converting enzyme inhibitor, perindopril, and a beta-blocker, propranolol, on cerebral arterioles in stroke-prone spontaneously hypertensive rats (SHRSP). The structure and mechanics of cerebral arterioles were examined in untreated Wistar-Kyoto rats (WKY) and SHRSP that were untreated or treated for 3 months with a high (2 mg/kg per day) or a low (0.3 mg/kg per day) dose of perindopril or propranolol (250 mg/kg per day) alone or in combination with the low dose of perindopril. We measured pressure, external diameter, and cross-sectional area of the vessel wall (CSA) in maximally dilated (with EDTA) cerebral arterioles. Treatment of SHRSP with the high dose of perindopril or the combination of propranolol and the low dose of perindopril normalized cerebral arteriolar mean pressure (50+/-1 [mean+/-SEM] and 43+/-2 mm Hg vs 50+/-1 mm Hg in WKY and 94+/-3 mm Hg in untreated SHRSP; P<0.05), pulse pressure (15+/-1 and 16+/-1 mm Hg vs 13+/-1 mm Hg in WKY and 35+/-1 mm Hg in untreated SHRSP; P<0.05), and CSA (1103+/-53 and 1099+/-51 microm2, respectively, vs 1057+/-49 microm2 in WKY and 1281+/-62 microm2 in untreated SHRSP; P<0.05). In contrast, treatment of SHRSP with the low dose of perindopril or propranolol alone did not normalize arteriolar pulse pressure (24+/-1 and 21+/-1 mm Hg) and failed to prevent increases in CSA (1282+/-77 and 1267+/-94 microm2). Treatment with either dose of perindopril or the combination of propranolol and perindopril significantly increased external diameter in cerebral arterioles of SHRSP (99+/-3, 103+/-2, and 98+/-3 microm vs 87+/-2 microm in untreated SHRSP; P<0.05), whereas propranolol alone did not (94+/-3 microm; P>0.05). These findings suggest that effects of angiotensin-converting enzyme inhibitors on cerebral arteriolar hypertrophy in SHRSP may depend primarily on their effects on arterial pressure, particularly pulse pressure, whereas their effects on cerebral arteriolar remodeling (defined as a reduction in external diameter) may be pressure independent.

Effects of chronic nitric oxide synthase inhibition on cerebral arterioles in rats.

We examined the effects of nitric oxide (NO) synthase inhibition on the structure and mechanics of cerebral arterioles. We measured pressure, diameter, and cross-sectional area of the vessel wall (histologically) in maximally dilated cerebral arterioles in Sprague-Dawley rats that were untreated or treated for 3 months with the NO synthase inhibitor N-nitro-L-arginine methyl ester (L-NAME; 10 mg/kg per day). Treatment with L-NAME increased cerebral arteriolar mean (87+/-6 versus 42+/-2 mm Hg, P<.05) and pulse (25+/-2 versus 13+/-2 mm Hg, P<.05) pressures, as well as cross-sectional area of the vessel wall (1839+/-70 versus 1019+/-58 microm2, P<.05) and external diameter (101+/-4 versus 87+/-2 microm, P<.05). These findings suggest that hypertension induced by NO synthase inhibition is accompanied by hypertrophy of the vessel wall and enlargement of cerebral arterioles in rats. To determine the role of cerebral arteriolar pulse pressure in hypertrophy of cerebral arterioles during inhibition of NO synthase, we measured the cross-sectional area of the vessel wall in rats treated with L-NAME that underwent unilateral carotid clipping. Unilateral carotid clipping failed to prevent increases in cross-sectional area of the vessel wall (1507+/-173 and 1613+/-148 microm2 in the clip and sham sides, respectively) in rats treated with L-NAME, even though increases in pulse pressure were prevented (16+/-1 and 27+/-1 mm Hg in the clip and sham sides, respectively, P<.05). These findings suggest that inhibition of NO synthase may promote hypertrophy of cerebral arterioles independently of increases in arteriolar pulse pressure.

Effects of endothelin receptor inhibition on cerebral arterioles in hypertensive rats.

The purpose of this study was to examine the effects of endothelin receptor inhibition on cerebral arterioles in stroke-prone spontaneously hypertensive rats (SHRSP). Structure and mechanics of cerebral arterioles were examined in untreated Wistar-Kyoto rats (WKY) and SHRSP that were either untreated or treated for 3 months with bosentan, an inhibitor of endothelin receptors (100 mg/kg per day). We measured pressure, external diameter, and cross-sectional area of the vessel wall (histologically) in maximally dilated (EDTA) arterioles on the cerebrum. Bosentan reduced but did not normalize arteriolar mean pressure (103 +/- 3 and 81 +/- 5 mm Hg in untreated and treated SHRSP versus 51 +/- 4 mm Hg in WKY, P < .05; mean +/- SEM) and pulse pressure (40 +/- 2 and 33 +/- 2 mm Hg in untreated and treated SHRSP versus 25 +/- 3 mm Hg in WKY, P < .05) in SHRSP. Cross-sectional area of the vessel wall (CSA) was increased in untreated SHRSP (1627 +/- 173 microm2), and CSA in treated SHRSP (1287 +/- 78 microm2) was similar to that in WKY (1299 +/- 65 microm2). Bosentan had no effect on reductions in external diameter (remodeling) of cerebral arterioles (104 +/- 7 and 96 +/- 4 microm in untreated and treated SHRSP compared with 126 +/- 7 microm in WKY, P < .05). Stress-strain curves indicate that bosentan had no significant effect on distensibility of arterioles on the cerebrum in SHRSP. The results suggest that endothelin-1 may contribute to the development of hypertrophy, but not remodeling or changes in distensibility, of cerebral arterioles in SHRSP.

Effects of increased pulse pressure on cerebral arterioles.

The goal of this study was to examine the hypothesis that increases in pulse pressure produce hypertrophy of cerebral arterioles, even in the absence of increases in mean pressure. Sprague-Dawley rats underwent creation of an arteriovenous fistula and clipping of one carotid artery at 1 month of age. Rats that underwent exposure of the abdominal aorta without fistula production and unilateral carotid clipping served as controls. At about 6 months of age, the mechanics of sham and clipped pial arterioles were examined in vivo in anesthetized rats. Stress-strain relations were calculated from measurements of pial arteriolar pressure (servo null) and diameter and cross-sectional area of the arteriolar wall. Point counting stereology was used to quantify individual components in the arteriolar wall. Before deactivation of smooth muscle with EDTA, cross-sectional areas of the vessel wall and pulse pressures in sham pial arterioles were significantly greater (P < .05) in arteriovenous fistula rats than in control rats (cross-sectional area, 1468 +/- 100 versus 1129 +/- 104 microns 2; pulse pressure, 26 +/- 1 versus 14 +/- 1 mm Hg). In contrast, systolic and mean pressures in sham arterioles were not significantly different and diastolic pressure was significantly less in arteriovenous fistula rats (systolic pressure, 69 +/- 1 versus 67 +/- 4 mm Hg; mean pressure, 52 +/- 2 versus 57 +/- 3 mm Hg; diastolic pressure, 43 +/- 2 versus 53 +/- 3 mm Hg). Carotid clipping normalized cross-sectional area of the vessel wall (1083 +/- 86 microns 2) and pulse pressure (12 +/- 1 mm Hg) in pial arterioles of arteriovenous fistula rats. During maximal dilatation, the stress-strain curve in sham arterioles of arteriovenous fistula rats was shifted to the right of the curve in control rats, which indicates that arteriovenous fistulae increase passive distensibility of cerebral arterioles. The proportion of distensible components in the vessel wall (smooth muscle, elastin, and endothelium) was increased in sham arterioles of arteriovenous fistula rats. These findings (1) suggest that increases in pulse pressure, even in the absence of increases in mean pressure, are sufficient to produce hypertrophy of cerebral arterioles and (2) provide support for the concept that increases in distensibility of cerebral arterioles in association with hypertrophy of the vessel wall may be related to alterations in wall composition.

Sick vessel syndrome. Recovery of atherosclerotic and hypertensive vessels.

This review describes vascular changes in atherosclerotic and hypertensive vessels as well as effects of treatment. Changes in vascular structure in both atherosclerosis and hypertension are characterized by thickening of the vessel wall and vascular "remodeling." Remodeling tends to preserve the size of the lumen in atherosclerotic vessels and results in a smaller lumen in hypertensive vessels. Changes in vascular function are characterized by preservation of smooth muscle relaxation, with the exception of activity of ATP-sensitive potassium channels, and dysfunction of endothelium. Regression of atherosclerosis, by treatment of hyperlipidemia, results in quite rapid removal of lipid from the vessel wall but with inconsistent improvement in maximal vasodilator capacity. In contrast, endothelial function improves during regression of atherosclerosis, and hyperresponsiveness to serotonin subsides rapidly. Effective treatment of hypertension produces regression of vascular hypertrophy, and some approaches (especially angiotensin-converting enzyme inhibitors) are effective in correcting vascular remodeling. Endothelium-dependent relaxation generally improves during antihypertensive treatment. Reduction in pulse pressure may be more important than reduction in mean arterial pressure in reversing the structural and functional abnormalities of hypertensive vessels.

Sick vessel syndrome: vascular changes in hypertension and atherosclerosis.

Hypertension and atherosclerosis are associated with structural and functional changes that may be collectively described as a 'sick vessel syndrome'. Structural changes in blood vessels (remodelling and hypertrophy) may be protective and adaptive. Functional changes in blood vessels include impairment of endothelium-dependent relaxation and impaired relaxation in response to activation of ATP-sensitive potassium channels. In general, vasorelaxation in response to direct activation of adenylate and guanylate cyclase is preserved in chronic hypertension and atherosclerosis. Vasoconstrictor responses to selected stimuli, such as serotonin, may be greatly potentiated. Impairment of endothelial function in combination with exaggeration of vasoconstrictor responses may predispose to vasospasm particularly during atherosclerosis.

Proportional arteriolar growth accompanies cardiac hypertrophy induced by volume overload.

Volume overload-induced cardiac hypertrophy is characterized by normal coronary reserve and maximal flow. Accordingly, we tested the hypothesis that both arteriolar and capillary growth are proportional to the magnitude of hypertrophy in this model. Five months after performing an aortocaval fistula [arteriovenous (A-V) shunt] in young rats, right and left ventricles were 61 and 55%, respectively, heavier than their sham controls. Using morphometric methods and image analysis, we found that increases in cardiac myocyte cross-sectional area accounted for approximately 50% of the hypertrophy and that arteriolar length density (LV) (7.5 +/- 0.9 and 7.0 +/- 0.4 mm/mm3) and the frequency distribution of arteriolar diameters were similar in the hearts from A-V shunt and control rats. Capillary LV in the right ventricle was similar in the two groups; in the left ventricle a significantly lower LV for the A-V shunt rats was noted only in the endomyocardium. Capillary volume density was not attenuated in the A-V shunt rats, since slightly larger luminal diameters compensated for any decrements in LV in the left ventricle. These findings provide an anatomic basis for the observation that maximal myocardial perfusion is not necessarily compromised in ventricular enlargement due to aortocaval fistula. Because diastolic volume is increased in this model and thereby provides a stretch on the microvasculature, our findings are consistent with those from other models of cardiac hypertrophy in which enhancement of mechanical factors is associated with angiogenesis.

Effects of local reduction in pressure on endothelium-dependent responses of cerebral arterioles.

BACKGROUND AND PURPOSE: The goal of this study was to examine effects of local reductions in intravascular pressure and dP/dt on endothelium-dependent responses of cerebral arterioles in normotensive Wistar-Kyoto rats (WKY) and stroke-prone spontaneously hypertensive rats (SHRSP). METHODS: WKY and SHRSP underwent clipping of one carotid artery at 1 month of age. At 6 months of age, responses of pial arterioles were examined in vivo in anesthetized rats. Bilateral craniotomies were performed to expose pial arterioles in the sham-operated and clipped cerebral hemispheres. Pressure (servo-null) was measured in sham-operated and clipped pial arterioles, and arteriolar diameter was measured before and during suffusion with bradykinin, A23187, and nitroprusside. RESULTS: Carotid clipping normalized pial arteriolar pulse pressure but not mean pressure in SHRSP. Responses of sham-operated pial arterioles to bradykinin and A23187 were less in SHRSP than in WKY. Responses of sham-operated pial arterioles to nitroprusside were greater in SHRSP than in WKY. Carotid clipping in SHRSP normalized responses of pial arterioles to bradykinin but not A23187 and had no effect on responses to nitroprusside. CONCLUSIONS: These findings suggest that elevated intravascular pressure per se may contribute to impairment of endothelium-dependent relaxation to at least some agonists in cerebral arterioles during chronic hypertension. Furthermore, the findings lead us to speculate that arteriolar pulse pressure may play a more important role than mean pressure in development of impaired endothelium dilatation during chronic hypertension.

Mechanics of large and small cerebral arteries in chronic hypertension.

The goal of this study was to investigate factors that contribute to reductions in internal diameter of large and small cerebral arteries during chronic hypertension. We measured diameter of second- and third-order branches of the posterior cerebral artery in vitro during maximal dilation with EDTA in 6-mo-old stroke-prone spontaneously hypertensive rats (SHRSP, n = 7) and Wistar-Kyoto rats (WKY, n = 7). Cross-sectional area of the vessel wall, measured histologically, was not significantly different at 70 mmHg in SHRSP and WKY in large or small branches of posterior cerebral artery. In large branches of posterior cerebral artery, external and internal diameters were significantly less at 70 mmHg in SHRSP than in WKY, whereas external and internal diameters converged at 0 mmHg in the two groups of rats. In small branches, on the other hand, external and internal diameters were significantly less at all levels of intravascular pressure in SHRSP than in WKY. The stress-strain relation in posterior cerebral artery of SHRSP was shifted to the left in large branches and to the right in small branches, which indicates that distensibility was reduced in large cerebral arteries of SHRSP and increased in small cerebral arteries. These findings suggest that different mechanisms are responsible for impairment of maximal dilator capacity in large and small cerebral arteries of SHRSP: reduced distensibility in large arteries and remodeling with reduced external diameter in small arteries. Furthermore the findings provide additional support for the concept that hypertrophy may not be a primary factor in impaired maximal dilation.

Mechanics and composition of cerebral arterioles in renal and spontaneously hypertensive rats.

The purpose of this study was to examine effects of hypertension on mechanics of cerebral arterioles in nongenetic and genetic models of chronic hypertension. Pressure (servo null) and diameter were measured in pial arterioles of anesthetized renal hypertensive rats (one-kidney, one clip), uninephrectomized normotensive rats, spontaneously hypertensive rats, and normotensive Wistar-Kyoto rats. During maximal dilatation with EDTA, external diameter of pial arterioles at 70 mm Hg pial arteriolar pressure was not significantly different in renal hypertensive and normotensive rats (86 +/- 5 [mean +/- SEM] versus 84 +/- 4 microns) but was less in spontaneously hypertensive rats than in Wistar-Kyoto rats (81 +/- 3 versus 92 +/- 3 microns; p < 0.05). Cross-sectional area of the arteriolar wall (histological) was greater in renal hypertensive than in normotensive rats (1,360 +/- 131 versus 952 +/- 89 microns 2; p < 0.05) and in spontaneously hypertensive rats than in Wistar-Kyoto rats (1,294 +/- 97 versus 817 +/- 86 microns 2; p < 0.05). The stress-strain relation obtained from pressure-diameter data during maximal dilatation with EDTA indicated that distensibility of pial arterioles, when fully relaxed, was greater in renal hypertensive and spontaneously hypertensive rats than in normotensive and Wistar-Kyoto rats. We used point-counting stereology to quantitate composition of pial arterioles in renal hypertensive rats. Cross-sectional area of smooth muscle and elastin was significantly greater in renal hypertensive than in normotensive rats (smooth muscle, 947 +/- 108 versus 620 +/- 62 microns 2; elastin, 101 +/- 11 versus 55 +/- 6 microns 2; p < 0.05), whereas cross-sectional area of collagen and basement membrane was not significantly different in the two groups (collagen, 6 +/- 1 versus 5 +/- 1 microns 2; basement membrane, 120 +/- 12 versus 104 +/- 8 microns 2). Thus, we conclude that 1) cerebral arterioles undergo hypertrophy in both renal hypertensive and spontaneously hypertensive rats; 2) cerebral arterioles in renal hypertensive rats do not undergo "remodeling" with a reduction in external diameter, whereas external diameter is smaller in spontaneously hypertensive than in Wistar-Kyoto rats; 3) distensibility of cerebral arterioles, when fully relaxed, is increased in renal hypertensive rats and is greater in spontaneously hypertensive than in Wistar-Kyoto rats; and 4) the distensible components of the arteriolar wall are increased disproportionately in cerebral arterioles of renal hypertensive rats, which may contribute to increases in arteriolar distensibility.

Effects of aging on cerebral vascular responses to serotonin in rats.

The purpose of this study was to examine effects of aging on responses of large cerebral arteries to serotonin. We measured cerebral microvascular pressure (with a micropipette and servo-null method), diameter of pial arterioles, and cerebral blood flow (microspheres) in adult (12- to 14-mo-old, n = 15) and aged (24- to 27-mo-old, n = 14) Wistar rats. Responses to intra-atrial infusion of serotonin (5 and 50 micrograms.kg-1.min-1) were examined. Infusion of the low dose of serotonin decreased mean arterial pressure and pial arteriolar pressure in adult and aged rats to similar levels. Cerebral blood flow was not reduced in adult or aged rats during infusion of the low dose of serotonin. The high dose of serotonin did not affect mean arterial pressure but reduced pial arteriolar pressure [from 46 +/- 4 to 23 +/- 2 (SE) in adult rats and from 52 +/- 3 to 18 +/- 4 mmHg in aged rats]. The high dose of serotonin increased large-artery resistance from 0.9 +/- 0.1 to 1.6 +/- 0.2 in adult rats and from 0.9 +/- 0.1 to 2.7 +/- 0.6 mmHg.ml-1.min.100 g in aged rats. Cerebral blood flow was reduced significantly in aged rats (from 59 +/- 3 to 41 +/- 6 ml.min-1.100 g-1), but not in adult rats, during infusion of the high dose of serotonin. We conclude that aging augments constrictor responses of large cerebral arteries to intravascular serotonin, which results in a reduction of cerebral blood flow in aged but not adult rats.

Vascular remodeling in hypertension.

Cerebral arterioles in stroke-prone spontaneously hypertensive rats (SHRSP) paradoxically become more distensible, despite hypertrophy of the vessel wall. Cerebral arterioles in SHRSP also undergo remodeling with a reduction in external diameter. Based on these findings, we have proposed the concept that remodeling of cerebral arterioles may be an important mechanism, in addition to hypertrophy, for encroachment on the vascular lumen in SHRSP. The purpose of this review is threefold. First, consequences of vascular hypertrophy that have been proposed previously are reviewed with an emphasis on the hypothesis that encroachment on the vascular lumen by hypertrophy is an important mechanism of altered vascular responses in chronic hypertension. Second, the concept of vascular remodeling is considered with an emphasis on the possibility that remodeling with a reduction in external diameter may contribute importantly to altered cerebral vascular responses in SHRSP. Finally, possible mechanisms of vascular remodeling are considered with an emphasis on the hypothesis that a reduction in external diameter may be related to a decrease in the length of individual smooth muscle cells without an increase in cell number, or an increase in the number of times each smooth muscle cell wraps around the arteriole.

Cerebral vascular changes during chronic hypertension: good guys and bad guys.

AIM: To examine new concepts concerning structural changes in cerebral blood vessels during chronic hypertension, and to examine mechanisms that lead to cerebral vascular complications, in light of the hypothesis that hypertensive vascular hypertrophy may be harmful. METHOD: Literature review. RESULTS: The evidence suggests that the current view is not correct in relation to the cerebral circulation. Vascular hypertrophy and remodeling appear to protect cerebral vessels during hypertension, instead of being harmful. Major cerebral vascular complications during hypertension may be largely due to endothelial dysfunction. One function of the cerebral endothelium is to serve as the blood-brain barrier. Disruption of the blood-brain barrier appears to mediate hypertensive encephalopathy. A second endothelial function is to modulate vascular tone. Abnormalities in vasoactive factors that are released by the endothelium (impaired vasodilator mechanisms and augmented vasoconstrictor mechanisms) may make an important contribution to the pathophysiology of transient ischemic episodes, and perhaps stroke, in chronic hypertension.

Drug-induced changes in mechanics and structure of cerebral arterioles.

BACKGROUND: Cerebral arterioles in stroke-prone spontaneously hypertensive rats (SHRSP) undergo remodeling with a reduction in external diameter, paradoxically becoming more distensible, despite hypertrophy of the vessel wall. HYPOTHESIS: Two concepts have been proposed. (1) Remodeling of cerebral arterioles is an important mechanism, in addition to hypertrophy, of encroachment on the vascular lumen in SHRSP. (2) Increases in arteriolar distensibility partly compensate cerebral arterioles for other factors, such as hypertrophy and remodeling, which reduce the dilator capacity of these arterioles in chronic hypertension. EVIDENCE: Recently, we have studied the effects of reducing blood pressure by drug treatment or carotid clipping on hypertrophy and remodeling of cerebral arterioles in SHRSP. Our findings suggest that (1) pulse pressure may be a more important stimulus than mean pressure for hypertrophy of cerebral blood vessels and (2) remodeling of cerebral arterioles may occur independently of hypertrophy. CONCLUSION: Treatment that effectively prevents vascular hypertrophy during chronic hypertension may not be effective in preventing remodeling, and may therefore fail to restore cerebral vascular function to normal.

Effect of antihypertensive treatment on focal cerebral infarction.

The goal of the current study was to determine whether treatment of hypertension reduces cerebral infarction after occlusion of the middle cerebral artery in stroke-prone spontaneously hypertensive rats (SHRSPs). Three-month-old SHRSPs received untreated drinking water or drinking water containing cilazapril, an angiotensin converting enzyme inhibitor, or hydralazine and hydrochlorothiazide. After 3 months of treatment, the left middle cerebral artery was occluded and neurological deficit was evaluated. Infarct volume was measured 3 days after occlusion using computer imaging techniques from brain slices. Cilazapril and hydralazine with hydrochlorothiazide were equally effective in reducing systolic blood pressure in SHRSPs. One day after occlusion of the middle cerebral artery, neurological deficit was decreased by both cilazapril and hydralazine with hydrochlorothiazide compared with untreated SHRSPs, and the deficit 3 days after occlusion was decreased significantly only by cilazapril. Infarct volume was 178 +/- 7 mm3 (mean +/- SEM) in untreated SHRSPs, and it was significantly reduced to 117 +/- 15 mm3 by hydralazine with hydrochlorothiazide and to 101 +/- 17 mm3 by cilazapril. Infarct volume in Wistar-Kyoto rats was 27 +/- 16 mm3. Thus, reduction in arterial pressure by hydralazine with hydrochlorothiazide or an angiotensin converting enzyme inhibitor is protective against focal cerebral ischemia in SHRSPs.