Pathophysiology and Clinical Relevance of Microvascular Remodeling in Arterial Hypertension

Long-term exposure to high blood pressure leads to systemic structural and functional changes of microcirculation, a condition named microvascular remodeling. Microvascular remodeling can be assessed in subcutaneous small resistance arteries or non-invasively at the retinal level using Scanning Laser Doppler Flowmetry and Adaptive Optics. Capillary rarefaction is also a marker of hypertensive vascular impairment resulting in a lack of nutrient and oxygen supply. In hypertension, microvascular remodeling and large artery damage are part of a vicious cycle that eventually leads to target organ damage and worsen cardio-renal-cerebrovascular outcomes. This review describes the inflammatory nature of microvascular remodeling and aims to unravel the association of microvascular remodeling with hypertension-mediated organ damage, also providing an overview on its clinical relevance.