The Effect of Blood Pressure Variability on Coronary Atherosclerosis Plaques

Abstract

Hypertension is one of the most important risk factors for coronary heart disease (CHD). The regulation of blood pressure plays a significant role in the development and prognosis of CHD. Blood pressure variability (BPV) refers to the degree of fluctuation of blood pressure over a period of time and is an important indicator of blood pressure stability. Blood pressure fluctuations are complex physiological phenomena, being affected by physiological and pharmacological effects and regulated by behavioral, environmental, hydrodynamic, and neural factors. According to the different time periods for measuring BPV, it can be divided into very short-term, short-term, mid-term, and long-term. Multiple cardiovascular disease animal models and clinical experiments have consistently indicated that abnormal BPV is closely related to coronary events and is a risk factor for CHD independently of average blood pressure. Thrombosis secondary to plaque rupture (PR) or plaque erosion can cause varying blood flow impairment, which is the main pathological basis of CHD. Plaque morphology and composition can influence the clinical outcome, treatment, and prognosis of patients with CHD. Research has shown that PR is more easily induced by hypertension. After adjusting for the traditional factors associated with plaque development, in recent years, some new discoveries have been made on the influence of abnormal BPV on the morphology and composition of coronary plaques and related mechanisms, including inflammation and hemodynamics. This article reviews the impact of BPV on coronary plaques and their related mechanisms, with a view to prevent the occurrence and development of CHD by controlling BPV and to provide new prevention and treatment strategies for the clinical treatment of abnormal blood pressure.

Understanding Atherosclerosis Pathophysiology: Can Additive Manufacturing Be Helpful?

“…Atherosclerosis is a chronic systemic inflammatory disease [ 23 ] associated with plaque accumulation within the vessel wall and characterized by intramural lipid retention coupled with inflammation and dyslipidemia [ 20 ]. Inflammation is, indeed, a critical event involved in the pathological process of atherosclerosis [ 24 ]. Generally, atherosclerosis spreads out in large and medium thick-walled systemic arteries, specifically near or into branching regions, or in vascular regions characterized by a low wall shear stress, where the circulation time of lipoproteins and cells is long enough so they can easily sediment and cross the arterial wall.…”

“…Just as with every vascular disease, the initial stage of atherosclerosis is triggered by a disturbance in blood flow, caused mainly by the exposition to different cardiovascular risk factors, external stimuli, or damage, that leads to a drastic change in the expression of regulatory molecules and a subsequent unbalanced release of pro- and anti-inflammatory factors, which in turn activates the endothelium [ 23 , 24 ].…”

“…SMCs, specifically vascular smooth muscle cells (VSMCs), play an important role in the formation and progression of atherosclerosis [ 24 ], thus, strongly affecting vessel and plaque biomechanics. The early stages of atherosclerotic plaque formation are characterized by a change of VSMCs’ phenotype from a contractile to a synthetic phenotype and, consequently, by a decrease in the expression of contractile proteins.…”

“…Additionally, as the synthetic VSMCs are less stiff than contractile VSMCs, the diseased blood vessel will be softer [ 32 ], with reported stiffness values as low as 2.6–2.9 kPa, obtained for rat aortas [ 33 ]. In advanced stages of atherosclerosis, VSMCs continuously suffer apoptosis and release large amounts of matrix metalloproteinase that degrade the extracellular matrix and thin the fibrous cap of plaques [ 24 ].…”

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“…Hypertension (HTN) is the leading preventable risk factor for cardiovascular disease (CVD) and premature death worldwide ( 1 , 2 ). The prevalence of HTN is rising globally, especially in low- and middle-income countries ( 3 ).…”