Related Experiment Videos
End-organ disease in hypertension: what have we learned?
1Hypertension Unit, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Insights
Sustained hypertension damages the heart, kidneys, and brain. Left ventricular hypertrophy (LVH) from hypertension increases cardiovascular risks, while kidney function and cerebral blood flow can decline, leading to stroke.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Neurology
Background:
- Sustained hypertension significantly impacts major organs, including the heart, kidneys, and brain.
- Cardiac adaptation involves left ventricular hypertrophy (LVH), which is increasingly recognized as a risk factor for cardiovascular events.
- Hypertension-induced changes in renal hemodynamics and cerebrovascular autoregulation contribute to organ damage.
Purpose of the Study:
- To review the detrimental effects of sustained hypertension on the heart, kidneys, and brain.
- To elucidate the mechanisms of cardiac, renal, and cerebrovascular adaptation to arterial hypertension.
- To highlight the clinical implications of these adaptations, including increased cardiovascular risk and organ dysfunction.
Main Methods:
- Review of existing literature on the physiological adaptations to hypertension in target organs.
- Analysis of data from epidemiological studies, such as the Framingham cohort, regarding LVH and cardiovascular outcomes.
- Examination of recent clinical data on renal function decline in hypertensive patients despite treatment.
Main Results:
- Left ventricular hypertrophy (LVH) in response to hypertension is associated with increased risk of sudden death and cardiovascular mortality, independent of blood pressure levels.
- Hypertension leads to decreased renal blood flow, increased filtration fraction, and elevated renal vascular resistance, often resulting in reduced glomerular filtration rate.
- Despite effective antihypertensive therapy, a substantial proportion of patients experience a decline in renal function. Cerebrovascular adaptations can lead to vascular dementia and stroke.
Conclusions:
- Left ventricular hypertrophy (LVH) is a critical indicator of cardiovascular risk in hypertension, extending beyond a simple adaptive response.
- Hypertension poses a significant threat to renal function, with potential for decline even under treatment.
- Cerebrovascular complications, including stroke and vascular dementia, are significant consequences of hypertension-induced vascular changes and altered autoregulation.
Abstract:
The major target organs that suffer from sustained hypertension are the heart, kidneys, and brain. Cardiac adaptation to arterial hypertension consists of left ventricular hypertrophy (LVH) of the concentric type, that is, an increase in wall thickness at the expense of chamber volume. However, LVH can no longer be considered a simple adaptive myocardial process serving to compensate for the increase in afterload and bring left ventricular wall stress back to normal. Data from the Framingham cohort have shown that the occurrence of LVH drastically increases the risk of sudden death and other cardiovascular morbidity and mortality irrespective of the levels of arterial pressure. Renal adaptation to arterial hypertension consists of a decrease in renal blood flow with elevations in filtration fraction and renal vascular resistance. With progressive hypertensive cardiovascular disease, glomerular filtration rate will fall as well. Recent data in patients with mild-to-moderate hypertension demonstrate that despite "efficacious" antihypertensive therapy, one-third to one-half of hypertensive patients may experience a significant decline in renal function. Cerebrovascular adaptation to hypertension consists of micro- and macrovascular disease leading to vascular dementia, or ischemic or hemorrhagic stroke. Cerebrovascular autoregulation, the mechanism by which cerebral blood flow is maintained, despite changes in arterial pressure, may be altered in hypertension.