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HYPOTHESIS AND THEORY article

Front. Med.
Sec. Family Medicine and Primary Care
Volume 11 - 2024 | doi: 10.3389/fmed.2024.1380632
This article is part of the Research Topic The Newer Paradigms in Hypertension Research and Management View all 4 articles

Nasal Turbinate Lymphatic Obstruction: A Proposed New Paradigm in the Etiology of Essential Hypertension

Provisionally accepted
William T. Phillips William T. Phillips 1*Joyce G. Schwartz Joyce G. Schwartz 2
  • 1 The University of Texas Health Science Center at San Antonio, San Antonio, United States
  • 2 Methodist Healthcare, San Antonio, Texas, United States

The final, formatted version of the article will be published soon.

    Hypertension affects an estimated 1.3 billion people worldwide and is considered the number one contributor to mortality via stroke, heart failure, renal failure, and dementia. Although the physiologic mechanisms leading to the development of essential hypertension are poorly understood, the regulation of cerebral perfusion has been proposed as a primary cause. This article proposes a novel etiology for essential hypertension. Our hypothesis developed from a review of nuclear medicine scans, where the authors observed a significantly abnormal increase in nasal turbinate vasodilation in hypertensive patients using quantitative region of interest analysis. The authors propose that nasal turbinate vasodilation and resultant blood pooling obstruct the flow of cerebrospinal fluid passing through nasal turbinate lymphatics, thereby increasing intracranial pressure. The authors discuss the glymphatic/lymphatic clearance system which is impaired with age, and at which time hypertension also develops. The increased intracranial pressure leads to compensatory hypertension via Cushing's mechanism, i.e., the selfish brain hypothesis. The nasal turbinate vasodilation, due to increased parasympathetic activity, occurs simultaneously along with the well-established increased sympathetic activity of the cardiovascular system. The increased parasympathetic activity is likely due to an autonomic imbalance secondary to the increase in worldwide consumption of processed food. This hypothesis explains the rapid worldwide rise in essential hypertension in the last 50 years and offers a novel mechanism and a new paradigm for the etiology of essential hypertension. This new paradigm offers compelling evidence for the modulation of parasympathetic nervous system activity as a novel treatment strategy, specifically targeting nasal turbinate regulation, to treat diseases such as hypertension, idiopathic intracranial hypertension, and degenerative brain

    Keywords: Hypertension, Intracranial Pressure, Cushing's mechanism, glymphatics, sympathetic activity, parasympathetic activity, brain self-protection, brain blood flow resistance

    Received: 01 Feb 2024; Accepted: 07 Aug 2024.

    Copyright: © 2024 Phillips and Schwartz. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: William T. Phillips, The University of Texas Health Science Center at San Antonio, San Antonio, United States

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