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[Hypertension: microvascular complications]
1INSERM U541, biologie et physiologie moléculaire du vaisseau, service de physiologie, explorations fonctionnelles, hôpital Lariboisière, 41, bd de la Chapelle, 75475 Paris.
Insights
Hypertension involves three main arteriolar abnormalities: increased vasoconstrictor tone, hypertrophic remodeling, and rarefaction. Recent therapeutic strategies now target these structural changes to manage high blood pressure.
Area of Science:
- Cardiovascular Physiology
- Vascular Biology
- Hypertension Research
Context:
- Arteriolar abnormalities are key contributors to increased systemic resistance in hypertension.
- These include elevated vasoconstrictor tone, hypertrophic remodeling, and microvascular rarefaction.
- The interplay and significance of these factors vary by organ and disease stage.
Purpose:
- To review the three primary arteriolar abnormalities in hypertension: increased vasoconstrictor tone, hypertrophic remodeling, and rarefaction.
- To examine the evolution of antihypertensive therapeutic strategies over the past decades.
- To highlight the shift towards targeting structural vascular changes.
Summary:
- Hypertension is characterized by arteriolar issues: sympathetic hyperactivity causing high vasoconstrictor tone, increased arteriole wall thickness (hypertrophic remodeling) narrowing lumens, and reduced microvascular density (rarefaction).
- Therapeutic approaches have evolved from solely vasomotor targets (vasodilators) to addressing hypertrophic remodeling since the mid-1980s.
- Current research increasingly focuses on vascular rarefaction as a significant factor, opening new avenues for correcting structural abnormalities.
Impact:
- Understanding these arteriolar changes is crucial for developing effective hypertension management.
- The evolution of treatment reflects a growing appreciation for structural vascular pathology in hypertension.
- Targeting arteriolar remodeling and rarefaction represents a promising frontier in antihypertensive therapy.
Abstract:
The arterioles, vessels situated before the capillary bed, are responsible for the increased systemic resistances characteristic of hypertension. In short, three abnormalities are observed in the arterioles of hypertensives: abnormally high vasoconstrictor tone, essentially due to sympathetic hyperactivity, hypertrophic remodelling or increased wall thickness/radius ratio of the arteriole promoting both the increase in vasoconstriction tone and reduction of the vascular lumen, rarefaction of the microvascular bed which contributes to the increase in the haemodynamic resistances. These three factors are observed to different degrees in all forms of hypertension; their influence varies with the organ involved and the stage of the disease. A change in therapeutic strategy has occurred over the last 20 years in the field of hypertension. Before the 1980's, anti-hypertensive therapy was essentially aimed at a vasomotor target: the drugs used had a vasodilatory effect on the resistive arterioles or decreased their response to vasoconstrictor agents. From the mid-1980's, a lot of research was made into the therapeutic possibilities of limiting or correcting the hypertrophic remodelling of the arteries and arterioles of hypertensive patients. In the last few years, the vascular rarefaction in hypertension has been considered to be a significant factor and the possibility of correcting the structural abnormality has become a new therapeutic option.