The Structural Factor of Hypertension

Abstract

P athophysiological studies have extensively investigated the structural factor in hypertension, including large and small artery remodeling and functional changes. Here, we review the recent literature on the alterations in small and large arteries in hypertension. We discuss the possible mechanisms underlying these abnormalities and we explain how they accompany and often precede hypertension. Finally, we propose an integrated pathophysiological approach to better understand how the cross-talk between large and small artery changes interacts in pressure wave transmission, exaggerates cardiac, brain, and kidney damage, and lead to cardiovascular and renal complications. We principally report on large and small artery in essential hypertension because this is the most dominant form. Other forms of hypertension, including renovascular hypertension, primary aldosteronism, and hypertension associated with diabetes mellitus, will be reported only for contrasting their characteristics with those of uncomplicated essential hypertension. For sake of clarity, we will oppose functional and structural changes, although both are interdependent and influence the global hemodynamic, and vice versa. Hypertension Compendium© 2015 American Heart Association, Inc. Abstract: Pathophysiological studies have extensively investigated the structural factor in hypertension, including large and small artery remodeling and functional changes. Here, we review the recent literature on the alterations in small and large arteries in hypertension. We discuss the possible mechanisms underlying these abnormalities and we explain how they accompany and often precede hypertension. Finally, we propose an integrated pathophysiological approach to better understand how the cross-talk between large and small artery changes interacts in pressure wave transmission, exaggerates cardiac, brain and kidney damage, and lead to cardiovascular and renal complications. We focus on patients with essential hypertension because this is the most prevalent form of hypertension, and describe other forms of hypertension only for contrasting their characteristics with those of uncomplicated essential hypertension. (Circ Res.

Effect of Wave Reflection and Arterial Stiffness on the Risk of Development of Hypertension in Japanese Men

“…In addition, MML analyses also revealed longitudinal associations of rAI and SBP2 with baPWV. Apart from arterial stiffness, as mentioned, increased peripheral reflectance related to peripheral vascular damage may also worsen pressure wave reflection, which could functionally increase arterial stiffness via elevation of central blood pressure 7, 8, 9. Consequently, arterial stiffness and pressure wave reflection may be additively associated with the development of hypertension.…”

“…Wave reflection has also been reported as a risk factor for the development of hypertension 3, 5, 16. In addition to arterial stiffness, which increases the speed of propagation of the pressure wave originating from the left ventricle along the arterial wall, peripheral wave reflectance also affects the wave reflection; thus, arterial stiffness and wave reflection may reflect partially different facets of damage in the arterial tree 7, 8, 9. The findings of the present study suggest that both baPWV, a marker of arterial stiffness, and rAI, a marker of wave reflection, are independent predictors of the risk of development of hypertension.…”

“…Based on the results of several prospective studies, arterial stiffness (ie, macrovascular damage) is recognized to be a key player in the development of hypertension 3, 4, 5. Alternatively, microvascular damage in the arterial tree has also been proposed as an important factor for the development of hypertension 6, 7. In the arterial tree, abnormal wave reflection is caused not only by the increased pressure wave propagation speed on the arterial wall, derived from increased arterial stiffness, but also by elevation of the amplitude of the reflected wave secondary to increased peripheral reflectance, derived from peripheral vascular damage 8, 9.…”

Association Between Elevated Pulse Pressure and High Resting Coronary Blood Flow Velocity in Patients With Angiographically Normal Epicardial Coronary Arteries

“…Increased PP is a raw but recognized marker of arterial stiffness in the clinical setting 10, 11, 14. Arterial stiffness, which is a natural consequence of aging, is accelerated in arterial hypertension and is primarily caused by reduced elasticity and excessive fibrosis, which involves both large and small arteries.…”

“…Arterial wall stiffening affects peripheral small arteries and microcirculation 6, 7, 8, 9. In addition, remodeling of small arteries provokes elevated peripheral vascular resistances, which can also contribute to arterial stiffness 10, 11. As a consequence, arterial stiffness is known to be a predictor of adverse cardiovascular outcomes,12, 13 whereas PP could be considered as an independent marker of preclinical cardiovascular disease 14, 15…”