Skip to main content

Advertisement

SpringerLink
Log in

Vascular abnormalities in hypertension: Cause, effect, or therapeutic target?

  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

Alteration in the physical properties of arterial blood vessels act as the substrate for end-organ damage and the occurrence of vascular events in hypertension. Structural and functional alteration in the microcirculation represents a prevalent and characteristic abnormality described in the earliest stages of hypertension. In addition to lowering arterial pressure, the importance of reversing structural abnormalities and restoring endothelial function has recently been emphasized. The normalization of microvascular function does not always correlate with blood pressure reduction and might depend on the class of antihypertensive agent employed. Because altered resistance vessel structure and function is a recognized hallmark of hypertension, institution of drug therapy that corrects the associated pathogenic vascular abnormalities is a rational, if unproven, clinical goal.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Staessen JA, Wang J, Bianchi G, Birkenhager WH: Essential hypertension. Lancet 2002, 361:1620–1641.

    Google Scholar 

  2. Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure: The JNC 7 report. JAMA 2003, 289:2560–2572.

    Article  Google Scholar 

  3. Guidelines Committee, 2003 European Society of Hypertension: European society of cardiology guidelines for the management of arterial hypertension. J Hypertens 2003, 21:1011–1054.

    Article  Google Scholar 

  4. Panza JA: High-normal blood pressure: more "high" than "normal." N Engl J Med 2001, 345:1337–1340.

    Article  PubMed  CAS  Google Scholar 

  5. Schiffrin EL: Beyond blood pressure: the endothelium and atherosclerosis progression. Am J Hypertens 2002, 15:115S-122S. Overview of the role of angiotensin II in modulating oxidative stress that promotes endothelial dysfunction, vascular remodeling, and atherogenesis.

    Article  PubMed  CAS  Google Scholar 

  6. Park JB, Schiffrin EL: Small artery remodelling is the most prevalent (earliest?) form of target organ damage in mild essential hypertension. J Hypertens 2001, 19:921–930. Important paper that provides compelling evidence that structural alterations in small resistance arteries are a common occurrence found in the earliest stages in hypertension.

    Article  PubMed  CAS  Google Scholar 

  7. McVeigh GE, Hamilton PK, Morgan DR: Evaluation of mechanical arterial properties: clinical experimental and therapeutic aspects. Clin Sci 2002, 102:51–67. Comprehensive overview of techniques used to evaluate the mechanical properties of arteries that hold potential to refine cardiovascular risk stratification and guide therapeutic interventions to optimize cardiovascular protection.

    Article  PubMed  Google Scholar 

  8. Pries AR, Secomb TW, Gaehtgens P: Structural autoregulation of terminal vascular beds: vascular adaptation and development of hypertension. Hypertension 1999, 33:153–161.

    PubMed  CAS  Google Scholar 

  9. Safar ME, Levy BI, Struijker-Boudier H: Current perspectives on arterial stiffness and pulse pressure in hypertension and cardiovascular diseases. Circulation 2003, 107:2864–2869. Overview of blood vessel propagation in the arterial system and explanation of how altered propagation can influence arterial structure and function and potentially accelerate disease development and the occurrence of vascular events.

    Article  PubMed  Google Scholar 

  10. van der Heijden-Spek JJ, Staessen JA, Fagard RH, et al.: Effect of age on brachial artery wall properties differs from the aorta and is gender dependent: a population study. Hypertension 2000, 35:637–642.

    PubMed  Google Scholar 

  11. Franklin SS, Larson MG, Khan SA, et al.: Does the relation of blood pressure to coronary heart disease risk change with aging? The Framingham Heart Study. Circulation 2001, 103:1245–1249.

    PubMed  CAS  Google Scholar 

  12. Miura K, Dyer AR, Greenland P, et al.: Pulse pressure compared with other blood pressure indexes in the prediction of 25-year cardiovascular and all-cause mortality rates. Hypertension 2001, 38:232–237.

    PubMed  CAS  Google Scholar 

  13. Laurent S, Boutouyrie P, Asmar R, et al.: Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 2001, 37:1236–1241.

    PubMed  CAS  Google Scholar 

  14. Suematsu M, Suzuki H, Delano FA, et al.: The inflammatory aspect of the microcirculation in hypertension: oxidative stress, leukocytes/endothelial interaction, apoptosis. Microcirculation 2002, 9:259–276.

    Article  PubMed  CAS  Google Scholar 

  15. Levy BI, Ambrosio G, Pries HR, Struijker-Boudier HAJ: Microcirculation in hypertension: a new target for treatment? Circulation 2001, 104:735–740. Excellent review emphasizing the importance of the microcirculation in the pathophysiology of hypertension and the rationale for targeting this section of the vasculature in the treatment of hypertension.

    PubMed  CAS  Google Scholar 

  16. Christensen KL, Mulvany MJ: Vasodilatation, not hypotension, improves resistance vessel design during treatment of essential hypertension: a literature survey. J Hypertens 2001, 19:1001–1006.

    Article  PubMed  CAS  Google Scholar 

  17. Rizzoni D, Porteri E, Boari GE, et al.: Prognostic significance of small-artery structure in hypertension. Circulation 2003, 108:2330–2335. An important study providing first evidence linking structural change in the microcirculation to the future occurrence of vascular events.

    Article  Google Scholar 

  18. Grey E, Bratteli C, Glasser SP, et al.: Reduced small artery but not large artery elasticity is an independent risk marker for cardiovascular events. Am J Hypertens 2003, 16:265–269.

    Article  PubMed  Google Scholar 

  19. Van Bortel L: Focus on small artery stiffness. J Hypertens 2002, 20:1707–1709.

    Article  PubMed  Google Scholar 

  20. Arosio E, De Marchi S, Prior M, et al.: Effects of nebivolol and atenolol on small arteries and microcirculatory endothelium-dependent dilation in hypertensive patients undergoing isometric stress. J Hypertens 2002, 20:1793–1797.

    Article  PubMed  CAS  Google Scholar 

  21. John S, Schmieder RE: Impaired endothelial function in arterial hypertension and hypercholesterolemia: potential mechanisms and differences. J Hypertens 2000, 18:363–374.

    Article  PubMed  CAS  Google Scholar 

  22. Taddei S, Salvetti A: Endothelial dysfunction in essential hypertension: clinical implications. J Hypertens 2002, 20:1671–1674.

    Article  PubMed  CAS  Google Scholar 

  23. McVeigh GE, Cohn JN: Endothelial dysfunction and the metabolic syndrome. Curr Diabetes Rep 2003, 3:87–92.

    Article  Google Scholar 

  24. Griendling KK, Fitzgerald GA: Oxidative stress and cardiovascular injury. Part II: animal and human studies. Circulation 2003, 108:2034–2040. Up-to-date overview of the pathogenic role of oxidative stress in promoting structural and functional change in the arterial vasculature.

    Article  PubMed  Google Scholar 

  25. Schüchinger V, Britten MB, Zeiher AM: Prognostic impact of coronary vasodilator dysfunction on adverse long-term outcome of coronary heart disease. Circulation 2000, 101:1899–1906.

    Google Scholar 

  26. McVeigh GE, Allen PB, Morgan DR, et al.: Nitric oxide modulation of blood vessel tone identified by arterial waveform analysis. Clin Sci 2001, 100:387–393.

    Article  PubMed  CAS  Google Scholar 

  27. Davies JI, Struthers AD: Pulse wave analysis and pulse wave velocity: a critical review of their strengths and weaknesses. J Hypertens 2003, 21:463–472. Overview highlighting the strengths and weaknesses of some of the noninvasive techniques currently employed that provide indirect information in relation to the mechanical properties of arteries.

    Article  PubMed  CAS  Google Scholar 

  28. McVeigh GE: Pulse waveform analysis and arterial wall properties. Hypertension 2003, 41:1010–1011. A commentary on the difficulties in definitively relating changes in pulse waveform morphology to specific mechanical descriptors of arterial wall properties responsible for the waveshape change.

    Article  PubMed  CAS  Google Scholar 

  29. Frank RN: The eye in hypertension. In Hypertension Primer, edn 3. Edited by Izzo JI Jr, Black HR. Philadelphia: Lippincott Williams & Wilkins; 2003:209–212.

    Google Scholar 

  30. Nichols WW, O’Rourke MF: Vascular impedance. In McDonald’s Blood Flow in Arteries, edn 4. Edited by Nichols WW, O’Rourke MF. New York: Oxford University Press; 1998:243–279.

    Google Scholar 

  31. Glasser SP, Arnett DK, McVeigh GE, et al.: The importance of arterial compliance in cardiovascular drug therapy. J Clin Pharmacol 1998, 38:202–212.

    PubMed  CAS  Google Scholar 

  32. Schiffrin EL, Park JB, Intengan HD, et al.: Correction of arterial structure and endothelial dysfunction in human essential hypertension by the angiotensin receptor antagonist losartan. Circulation 2000, 101:1653–1659. Important paper that shows restoration of microvasculature structure and function in hypertension can be independent of blood pressure reduction but dependent on the antihypertensive agent employed.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Therapeutics and Pharmacology, Queen’s University Belfast, Whitla Medical Building, 97 Lisburn Road, BT9 7BL, Belfast, Northern Ireland

    Gary E. McVeigh MD, PhD, Rick Plumb MD & Sinead Hughes MD

Authors
  1. Gary E. McVeigh MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rick Plumb MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sinead Hughes MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

McVeigh, G.E., Plumb, R. & Hughes, S. Vascular abnormalities in hypertension: Cause, effect, or therapeutic target?. Current Science Inc 6, 171–176 (2004). https://doi.org/10.1007/s11906-004-0065-x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11906-004-0065-x

Keywords

Search

Navigation