Editorial Commentary Cerebrovascular Challenges in Diabetic Patients The Pressure Is on to Maintain Perfusion

In this edition of Hypertension, Kim et al1 report thatcerebral perfusion is differentially effected by pharmaco-logical blood pressure treatment in hypertensive patients, uncomplicated type II diabetics, and type II diabetics with microvascular complications. Specifically, they reported a progressive decrease in cerebral blood flow after 6 months of antihypertensive medication in diabetics with microvascular complications, whereas cerebral blood flow in hypertensive or uncomplicated diabetics was only marginally reduced by treatment. In addition, the diabetics with microvascular com-plications demonstrated a blunted cerebral responsiveness to CO2 but similar middle cerebral artery blood velocity com-pared with hypertensives and uncomplicated diabetics before treatment for their hypertension. However, it is unknown whether the blunted cerebral vasodilator responses at baseline were caused by the same mechanisms that reduced middl