-Arterial smooth muscle hypertrophy allows for preserved autoregulation despite longstanding hypertension but at the cost of impaired dilatation at lower pressures; the latter can result in symptoms from decreased cerebral blood flow.
-Over time, the autoregulatory curve can be reset with BP control. As such, the symptoms of hypoperfusion should not be confused with a medication "allergy" and
are not a contraindication to gradual reduction in BP. Rather, patients should be educated and reassured that symptoms will improve with time.
-Since these symptoms are more pronounced in those with longstanding or marked elevations in pressures, I tend to "start low, go slow."
-Shortcomings: The study contained only a dozen patients; "healthy controls" had comorbids and one had hypertension. However, these results are consistent with the overall literature; more recent studies focus on esoteric aspects of the autoregulatory process.