The heart, macrocirculation and microcirculation in hypertension: a unifying hypothesis.

Area of Science:

• Cardiovascular Physiology
• Hypertension Pathophysiology

Background:

• Epidemiological studies highlight pulse pressure and mean arterial pressure (MAP) as critical risk factors for hypertension-related cardiovascular disease.
• Pulse pressure reflects the pulsatile component of blood pressure, influenced by cardiac function, arterial compliance, and wave reflections.
• MAP represents the steady component, determined by cardiac output and peripheral vascular resistance.

Purpose of the Study:

• To emphasize the distinct physiological determinants of pulse pressure and MAP.
• To explore the structural alterations in the heart and vasculature associated with hypertension.
• To underscore the necessity of considering both pulsatile and steady blood pressure components for understanding hypertensive disease.

Main Methods:

• Review of epidemiological findings on blood pressure components and cardiovascular risk.
• Analysis of cardiovascular system's structural determinants of pulse pressure and MAP.
• Examination of molecular pathways involved in cardiovascular remodeling under physical forces.

Main Results:

• Hypertension is linked to cardiac hypertrophy, fibrosis, arterial stiffening, and microvascular rarefaction.
• Both structural and functional aspects of the cardiovascular system influence pulse pressure and MAP.
• Molecular mechanisms underlying cardiovascular remodeling due to physical forces are being elucidated.

Conclusions:

• Accurate understanding of hypertensive disease pathophysiology requires consideration of both pulse pressure and MAP.
• Structural changes in the heart and vasculature are significant consequences of hypertension.
• Integrated analysis of pulsatile and steady blood pressure is vital for effective hypertension management and prevention of target-organ damage.