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(Hypertension. 2005;46:982.)
© 2005 American Heart Association, Inc.

Part 2 Original Articles

Arterial Compression of the Retro-Olivary Sulcus of the Ventrolateral Medulla in Essential Hypertension and Diabetes

From the Division of Neurosurgery (J.S.N., S.J.D., S.J.P.), Department of Neurosciences, Medical University of South Carolina, Charleston, SC; and the Department of Biostatistics (J.S.N.), Bioinformatics, and Epidemiology, Medical University of South Carolina, Charleston, SC.

Correspondence to Dr Joyce S. Nicholas, Medical University of South Carolina, Department of Biostatistics, Bioinformatics, and Epidemiology, 135 Cannon St, Suite 303, PO Box 250835, Charleston, SC 29425. E-mail nicholjs{at}musc.edu

Pulsatile arterial compression in the retro-olivary sulcus along the surface of the ventrolateral medulla has been postulated as a mechanism in both essential hypertension and diabetes. The objective of this study was to test the independent effect of arterial compression in the retro-olivary sulcus on each of these diseases, using separate logistic regression models to control for other known risk factors. Study design was case–control. The study population consisted of 147 consecutive patients treated for neurological conditions requiring MRI of the posterior cranial fossa. Information on essential hypertension, diabetes, and risk factors for each disease was abstracted from medical records. Presence of arterial compression was determined by blinded review of magnetic resonance images. In the essential hypertension analysis, odds of arterial compression among hypertensive patients were 2.99-times the odds among normotensive subjects (P=0.04), controlling for hypertension risk factors such as age, body mass index, race, diabetes, and family history of hypertension. Of compressed hypertensive subjects, 56% were compressed on the left and 44% were compressed on the right. In the diabetes analysis, odds of arterial compression among diabetic subjects were 1.14-times the odds among nondiabetic subjects (P=0.83). Of compressed diabetic subjects, 60% were compressed on the left, and 40% were compressed on the right. Results suggest that arterial compression of the retro-olivary sulcus may be an independent risk factor for essential hypertension in this population, supporting the postulate for a treatable (with microvascular decompression) neural mechanism for essential hypertension. However, in the diabetic population, the slight increase in the odds of arterial compression was not significant.

Key Words: arterial compression • diabetes mellitus • hypertension, essential