Department of Radiology, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom (N.E.M., E.R., K.M.).
Cardionomics Research Group, School of Physiology, Pharmacology and Neurosciences, University of Bristol, United Kingdom (N.E.M., K.M., T.H., A.K.N., E.C.H.).
Hypertension. 2022 Jun;79(6):1265-1274. doi: 10.1161/HYPERTENSIONAHA.121.18612. Epub 2022 Mar 16.
Variants in the posterior anatomy of the cerebral circulation are associated with hypertension and lower cerebral blood flow in midlife (age ≈55 years); however, whether these variants are a result of aging or long-term exposure to high blood pressure is unclear. Additionally, the role these variants play in early onset of hypertension (<40 years) and poor cerebral perfusion in this population is unknown.
We retrospectively examined whether specific cerebrovascular variants (vertebral artery hypoplasia and absent/hypoplastic posterior communicating arteries (an incomplete posterior circle of Willis) measured via magnetic resonance angiography) were associated with a diagnosis of hypertension in 220 young adults (<40 years; n=164 primary hypertensive [mean age±SD, 32±6 years] and n=56 [30±6 years] normotensive adults). Whether cerebrovascular variants were associated with lower cerebral blood flow (phase-contrast angiography) was measured in the hypertensive group only (n=146).
Binary logistic regression (adjusted for age, sex, and body mass index) showed that vertebral artery hypoplasia with an incomplete posterior circle of Willis was associated with hypertension diagnosis (<0.001, odds ratio; 11.79 [95% CI, 3.34-41.58]). Vertebral artery hypoplasia plus an incomplete circle of Willis was associated with lower cerebral blood flow in young adults with hypertension (=0.0172).
Vertebral artery hypoplasia plus an incomplete posterior circle of Willis independently predicts hypertension in young adults suggesting that this variant is not acquired with aging into midlife. Importantly this variant combination was associated with lower cerebral perfusion, which may have long-term consequences on cerebrovascular health in young adults with hypertension.
大脑循环后部解剖结构的变异与中年时期（约 55 岁）的高血压和脑血流量降低有关；然而，这些变异是衰老的结果还是长期高血压暴露的结果尚不清楚。此外，这些变异在该人群中高血压（<40 岁）和脑灌注不良的早期发病中的作用尚不清楚。
我们回顾性地研究了通过磁共振血管造影测量的特定脑血管变异（椎动脉发育不良和后交通动脉缺失/发育不良（不完整的后循环 Willis 环））是否与 220 名年轻成年人（<40 岁；原发性高血压组 164 名[平均年龄±标准差，32±6 岁]和正常血压组 56 名[30±6 岁]）的高血压诊断有关。仅在高血压组（n=146）中测量了脑血管变异与脑血流量降低（相位对比血管造影）之间的关系。
二元逻辑回归（调整年龄、性别和体重指数）显示，椎动脉发育不良伴不完整的后循环 Willis 环与高血压诊断相关（<0.001，优势比；11.79[95%CI，3.34-41.58]）。椎动脉发育不良加不完整的 Willis 环与年轻高血压成年人的脑血流量降低有关（=0.0172）。
椎动脉发育不良加不完整的后循环 Willis 环独立预测年轻成年人的高血压，表明这种变异不是在中年时期随着衰老而获得的。重要的是，这种变异组合与脑灌注降低有关，这可能对年轻高血压成年人的脑血管健康产生长期影响。
