Arterial compression of the retro-olivary sulcus of the medulla in essential hypertension: a multivariate analysis.
OBJECTIVE
Pulsatile arterial compression (AC) of the ventrolateral medulla (VLM) has been postulated to cause neurogenically mediated essential hypertension (EHTN). We aimed to establish whether the association between AC of specifically the retro-olivary sulcus (ROS) of the VLM and EHTN was significant, while controlling for other risks associated with EHTN.


METHODS
Case-control study.


METHODS
Posterior fossa magnetic resonance imaging scans of 131 subjects, including 58 subjects with EHTN and 73 normotensives, were reviewed to determine the presence of AC in the ROS. The history of other risk factors for EHTN was obtained by reviewing medical records.


RESULTS
Multivariate logistic regression analysis of these data shows a significant association between AC in the ROS (right and/or left) and EHTN [odds ratio (OR) = 3.03, 95% confidence interval (CI) = 1.30, 7.06]. This analysis was done controlling for other known EHTN risk factors such as age, race, sex, diabetes, and obesity. A secondary analysis also controlling for these variables shows that AC of both the right and left ROS are independently associated with EHTN (right AC: OR = 5.04, 95% CI = 1.33, 19.17; left AC: OR = 3.39, 95% CI = 1.20, 9.60).


CONCLUSIONS
In this retrospective study of subjects with EHTN and normotensive controls that had undergone magnetic resonance imaging of the posterior fossa, AC of the ROS on either side of the medulla is a significant independent risk factor in EHTN. Further studies are required to determine whether this is true for the general population of patients with neurogenically mediated EHTN.
Coffee
Robert E
RE
College of Medicine, Medical University of South Carolina, Charleston, 29425, USA.
Nicholas
Joyce S
JS
Egan
Brent M
BM
Rumboldt
Zoran
Z
D'Agostino
Sabino
S
Patel
Sunil J
SJ
D000328:Adult; D001158:Arteries / Q000473:pathology / Q000503:physiopathology*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000473:pathology / Q000503:physiopathology*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000473:pathology / Q000503:physiopathology*; D008875:Middle Aged; D015999:Multivariate Analysis