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Hypertension (Dallas, Tex. : 1979)
Published

Chronic Hypertension and the Brain's Waste Drainage System

Authors

Marah Alian, Christopher Le, Anna Williams, Joanna Wardlaw, Helene Benveniste

Abstract

Hypertension. 2026 Sep 17. doi: 10.1161/HYPERTENSIONAHA.126.26767. Online ahead of print.

ABSTRACT

An important system for brain waste clearance comprises a series of interconnected fluid and tissue compartments: the cerebrospinal fluid compartment, the glymphatic system, and the dura with the meningeal lymphatic vasculature, which drains to the cervical lymphatics. Although exchanges between these compartments are increasingly well documented, the mechanisms underlying their crosstalk and especially the regulation of brain waste clearance efficiency-including the role of immune surveillance along this pathway-remain incompletely understood. This interconnected pathway, designated the glymphatic-meningeal-cervical-lymphatic axis, is critically dependent on the cerebral vasculature, both structurally and functionally. Yet given this intimate vascular dependence, the effects of chronic hypertension-one of the most prevalent chronic diseases worldwide-on the structural and functional integrity of this axis remain remarkably understudied. This review examines each component of this pathway in physiological sequence, evaluating the evidence for hypertension-related dysfunction at each node and identifying where critical gaps remain.

PMID:42751772 | DOI:10.1161/HYPERTENSIONAHA.126.26767

UK DRI Authors

Anna Williams

Prof Anna Williams

UK DRI Affiliate Member - Edinburgh

Professor of Regenerative Neurology, University of Edinburgh

Prof Anna Williams
Joanna Wardlaw profile image

Prof Joanna Wardlaw

Group Leader and Clinical Director of the CVDR

Causes, mechanisms, clinical features, diagnosis, consequences, outcomes and treatment of cerebral small vessel disease focusing on clinical studies.

Prof Joanna Wardlaw