Cerebral blood flow in untreated and treated hypertension.

Cerebral blood flow (CBF) is the same in hypertensive and normotensive man without neurological deficit. Chronic hypertension shifts the lower and upper blood pressure limits of CBF autoregulation towards higher pressure. Acute blood pressure reduction will lower CBF only if the pressure is taken below the lower limit of autoregulation. Added to this, some drugs are cerebral vasodilatators and have the potential for paralysing autoregulation and raising intracranial pressure, an effect also seen with at least some calcium antagonists. Converting enzyme inhibitors improve autoregulation during hypotension, probably by releasing angiotensin II dependent tone in the larger cerebral resistance vessels. With chronic antihypertensive treatment, CBF autoregulation may re-adapt towards normal. Converting enzyme inhibitors when given chronically probably retain their beneficial effect on the lower limit of autoregulation. Apart from this, it is uncertain whether there are chronic pharmacological effects of antihypertensive drugs directly on the cerebral circulation.