Pathophysiology of hypertension: interactions between macro and microvascular alterations through endothelial...

Area of Science:

• Cardiovascular Medicine
• Vascular Biology
• Hypertension Pathophysiology

Background:

• Hypertension is a chronic disorder characterized by macrovascular and microvascular changes.
• These alterations include arterial stiffening, altered pulse pressure, and microvascular damage, leading to organ damage.
• Vascular changes are interconnected, increasing hemodynamic load and arterial damage.

Purpose of the Study:

• To explore the precursor role of vascular alterations in hypertension development.
• To provide new insights for preventive and therapeutic strategies targeting both macro and microvasculature.
• To revisit the pathophysiology of hypertension considering macro and microvascular contributions.

Main Methods:

• Analysis of functional and structural changes in macrovasculature (arterial stiffness, wave reflection).
• Assessment of microvascular alterations (wall-to-lumen ratio, vasomotor tone, rarefaction).
• Investigation of the role of metabolic burden and oxidative stress in endothelial injury and vascular changes.

Main Results:

• Macrovascular alterations include arterial stiffening and altered pulse pressure amplification.
• Microvascular alterations involve changes in arterioles, vasomotor tone, and network density, leading to impaired tissue perfusion.
• Vascular alterations are intercorrelated and contribute to increased hemodynamic load and organ damage.

Conclusions:

• Vascular alterations, both macro and microvascular, are central to hypertension pathophysiology.
• These alterations may precede the onset of hypertension, suggesting a precursor role.
• Endothelial dysfunction is implicated as a precursor to microvascular alterations in hypertension.