**6. Conclusions**

In conclusion, the regulation of vascular tone involves a complex set of pathways with myogenic, shear, and metabolic control. The mechanical influences of pressure and flow serve as a stimulus for the myogenic and shear responses to set a basal level of tone over a wide range so that metabolic factors have room to produce vasoactive responses on the vasculature. Due to the paramount importance of precise cerebral blood flow control these mechanisms are particularly pronounced and redundant in the cerebral circulation allowing for greater protection against insufficient perfusion or edema and capillary damage in situations of hypotension and hypertension respectively. However, due to the complexity of these homeostatic blood flow mechanisms there is the potential for the development of a pathological state. MetS presents a constellation of cardiovascular risk factors that are highly linked to the development of such cerebrovascular pathologies increasing the risk of stroke, TIA, and vascular dementia. The risk factors associated with MetS result in vascular remodeling which decreases the lumen size and increases stiffness and when paired with endothelial dysfunction and increased activation of the vascular smooth muscle it promotes increased cerebrovascular resistance. This right shifts the autoregulatory zone of myogenic regulation allowing for enhanced protection from hypertension but leaves cerebral tissue vulnerable to underperfusion. Controlling these risk factors and well as implementing targeted therapeutic strategies aimed at ameliorating the regulation of cerebrovascular tone has the potential to restore function in the cerebral circulation and improve current negative outcomes associated with MetS and cerebrovascular dysfunction.
