Vascular remodeling in hypertension

Abstract

Changes in blood vessel morphology and function, including vascular remodeling, microvascular rarefaction, and endothelial dysfunction, accompany the increase in peripheral vascular resistance and blood pressure that are characteristics of hypertension. Blood vessels are capable of structural alteration. Remodeling of large and small arteries in hypertension contributes to an elevation in blood pressure and also may participate in the complications of hypertension. Large arteries exhibit increased lumen size and thickened media, which contribute to an elevated systolic blood pressure and pulse pressure. In small-resistance arteries, smooth muscle cells are restructured around a smaller lumen, with eutrophic inward remodeling, particularly in milder forms of hypertension; in severe forms of hypertension and in secondary hypertension (renovascular hypertension), hypertrophic inward remodeling has been reported. Finally, reduction of microvessel density, that is, capillary rarefaction which decreases total arteriolar and capillary cross-sectional area, and small artery remodeling which increases peripheral resistance in the basal state, together increase diastolic blood pressure and decrease vascular reserve.