Review articleFibrosis in hypertensive heart disease: role of the renin-angiotensin-aldosterone system
Section snippets
Clinical evidence
The essential criterion in defining hypertensive heart disease (HHD) is a greater than normal heart mass in the absence of a cause other than arterial hypertension. It is now accepted, however, that besides left ventricular hypertrophy (LVH), alterations in myocardial structure as listed below account for loss of tissue homogeneity and pathologic remodeling that appears in HHD:
Cellular alterations
Cardiomyocytes
Hypertrophy, atrophy, apoptosis, necrosis
Noncardiomyocytes
Hyperplasia and apoptosis
Role of angiotensin II in myocardial fibrosis
Various lines of evidence support a role for ANGII as a critical candidate factor to induce myocardial fibrosis in HHD.
Summary
Structural homogeneity of cardiac tissue is governed by mechanical and humoral factors that regulate cell growth, apoptosis, phenotype, and extracellular matrix turnover. ANGII has endocrine, autocrine, and paracrine properties that influence the behavior of cardiac cells and matrix by AT1 receptor binding. Various paradigms have been suggested, including ANGII-mediated up-regulation of collagen types I and III formation and deposition in cardiac conditions, such as HHD. A growing body of
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