The blood-brain barrier (BBB) is a critical barrier that provides both metabolic and physical protection to an immune-privileged central nervous system. The BBB has been shown to be disrupted in hypertension. This review addresses the importance of the BBB in maintaining homeostasis in the context of diseases related to autonomic dysfunction such as hypertension. We highlight the potentially important roles of the immune system and neurovascular unit in the maintenance of the BBB, whereby dysregulation may lead to autonomic dysfunction in diseases such as heart failure and hypertension. Circulating leukocytes and factors such as angiotensin II and pro-inflammatory cytokines are thought to ultimately down-regulate endothelial tight junction proteins that are a critical component of the BBB. The specific mechanisms underlying BBB disruption and their role in contributing to autonomic dysfunction is not yet fully understood but is a growing area of interest. A greater understanding of these systems and advances in our knowledge of the molecular mechanisms causing BBB disruption, will allow for the development of future therapeutic interventions in the treatment of autonomic imbalance associated with diseases such as heart failure and hypertension.
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