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[Hypertension as a biological marker of systemic atherosclerotic disease]
Oscar Román A1, Marta Badilla S, Ana María Dussaubat A
1Servicio Cardiovascular, Hospital San Borja-Arriarán, Santiago de Chile. oscarromanalemany@hotmail.com
Insights
Hypertension and atherosclerosis are closely linked, with early arterial damage preceding high blood pressure. This suggests hypertension may signal underlying atherosclerotic disease, shifting focus to vascular damage for prognosis.
Area of Science:
- Cardiovascular Medicine
- Pathophysiology
- Medical Research
Context:
- Hypertension and atherosclerosis share common risk factors and a strong pathophysiological link.
- Vascular damage and target organ injury can occur before significant blood pressure elevation.
- Current mortality risk assessment for hypertension extends to pre-hypertension levels.
Purpose:
- To propose a new paradigm for classifying hypertension severity based on vascular damage.
- To reframe hypertension as a potential marker for evolving atherosclerotic processes.
- To introduce the concept of "hypertensive atherosclerotic disease" or "systemic atherosclerotic disease".
Summary:
- Hypertension is intrinsically linked to atherosclerosis, causing damage to target organs.
- The risk of mortality associated with hypertension increases even below normal blood pressure levels.
- Initial arterial wall and target organ damage precede significant blood pressure elevation, suggesting hypertension may indicate underlying atherosclerosis.
Impact:
- This new paradigm shifts the focus from blood pressure values to the extent of vascular damage for prognosis and management.
- It redefines hypertension as a potential biological marker for the progression of atherosclerotic disease.
- The concept of "hypertensive atherosclerotic disease" offers a unified approach to understanding and treating systemic vascular damage.
Abstract:
There is a close link between hypertension and atherosderosis. Hypertension causes atherosclerotic damage of several organs, called target organs and the risk factors for hypertension and atherosderosis are very similar. The risk of mortality associated to hypertension increases with blood pressure values below the cutoff point of normality (140/90 mm Hg), even below 130/85 mm Hg, and includes a stage called pre hypertension. Moreover, the initial damage of the arterial walls and target organs are present before there is a significant elevation of blood pressure. Therefore, hypertension could become a biological marker of the evolution of an underlying atherosclerotic process. A new pathophysiological paradigm has been proposed in which the severity of hypertension is not classified according to blood pressure values, but rather on the initiation and progression of vascular damage among target organs. These alterations determine the prognosis and management of systemic vascular damage that can be called "hypertensive atherosclerotic disease" or simply systemic atherosclerotic disease.
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