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What determines the formation of a berry aneurysm more? Hypertension or genetics? I had a question asking this on a NBME while back.
 

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Trigger versus genetics

Hypertension is the trigger for advancement and rupture of the aneurysm but you have to be genetically predisposed first.

Other analogies would be for example a viral infection triggering diabetes or MS in a genetically predisposed individual.
 
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