Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, 2109, Australia.
St. Vincent's Clinic, Victor Chang Cardiac Research Institute, University of New South Wales, Sydney, Australia.
Curr Hypertens Rep. 2018 Mar 19;20(3):20. doi: 10.1007/s11906-018-0822-x.
Concepts of pulsatile arterial haemodynamics, including relationships between oscillatory blood pressure and flow in systemic arteries, arterial stiffness and wave propagation phenomena have provided basic understanding of underlying haemodynamic mechanisms associated with elevated arterial blood pressure as a major factor of cardiovascular risk, particularly the deleterious effects of isolated systolic hypertension in the elderly. This topical review assesses the effects of pulsatility of blood pressure and flow in the systemic arteries on the brain. The review builds on the emerging notion of the "pulsating brain", taking into account the high throughput of blood flow in the cerebral circulation in the presence of mechanisms involved in ensuring efficient and regulated cerebral perfusion.
Recent studies have provided evidence of the relevance of pulsatility and hypertension in the following areas: (i) pressure and flow pulsatility and regulation of cerebral blood flow, (ii) cerebral and systemic haemodynamics, hypertension and brain pathologies (cognitive impairment, dementia, Alzheimer's disease), (iii) stroke and cerebral small vessel disease, (iv) cerebral haemodynamics and noninvasive estimation of cerebral vascular impedance, (v) cerebral and systemic pulsatile haemodynamics and intracranial pressure, (iv) response of brain endothelial cells to cyclic mechanical stretch and increase in amyloid burden. Studies to date, producing increasing epidemiological, clinical and experimental evidence, suggest a potentially significant role of systemic haemodynamic pulsatility on structure and function of the brain.
脉动动脉血液动力学的概念，包括系统动脉中振荡血压与血流之间的关系、动脉僵硬度和波传播现象，为与升高的动脉血压相关的潜在血液动力学机制提供了基本理解，而升高的动脉血压是心血管风险的一个主要因素，特别是在老年人中孤立性收缩期高血压的有害影响。本专题综述评估了系统动脉中血压和血流的脉动对大脑的影响。该综述基于“脉动大脑”的新观念，考虑到在涉及确保有效和调节性脑灌注的机制存在的情况下，脑循环中血流的高通量。
最近的研究提供了证据表明脉动和高血压在以下方面的相关性：（i）压力和血流脉动以及脑血流的调节，（ii）脑和全身血液动力学、高血压和脑部病变（认知障碍、痴呆、阿尔茨海默病），（iii）中风和脑小血管疾病，（iv）脑血液动力学和脑血管阻抗的无创估计，（v）脑和全身脉动血液动力学和颅内压，（iv）脑内皮细胞对周期性机械拉伸和淀粉样蛋白负荷增加的反应。迄今为止的研究产生了越来越多的流行病学、临床和实验证据，表明全身血液动力学脉动对大脑的结构和功能可能具有重要作用。
