Hypertension, stroke, and endothelium.

Endothelial dysfunction, the complex, multifaceted, pathologic product of various vasculotoxic agents or injuries, is an intermediate attractant phenotype of cardiovascular diseases that usually has a long and unpredictable natural history. Furthermore, endothelial dysfunction may not only represent a vascular disease marker, but actually may play an important pathogenetic role that leads to the progression of the disease and the unfavorable outcomes. Among these vascular diseases, cerebrovascular accidents, particularly stroke, clearly represent a paradigmatic example of the potential role of dysfunctional endothelium. Elevated blood pressure has long been recognized as one of the most important risk factors for stroke; other factors, however, seem to play an important role. Indeed, epidemiologic evidence suggests that, in spite of an improved control of blood pressure, the secular trends of stroke in well-controlled populations are increasing. In this brief review, we analyze current evidence suggesting that endothelial dysfunction can play a role in the pathogenesis of ischemic stroke.