Review of the literature and data from our own studies on changes in cerebral vessels during arterial hypertension and smoking in the clinic and experiment. Data from transcranial Doppler sonography, duplex scanning and magnetic resonance imaging of the cerebral vascular bed are presented. A decrease in the linear velocity of blood flow, an increase in the vascular resistance index and a greater severity of cerebral atherosclerosis in arterial hypertension and chronic tobacco smoking have been shown. A direct relationship has been established between the intensity of smoking and the incidence of atherosclerotic plaques, including hemodynamically significant stenoses. Severe vasomotor disorders of the brain were established, in the form of loss of the endothelial-dependent component of vasodilation and an increase in vasoconstrictor effects.