Hypertension and microvascular remodelling.
In the present review, microvascular remodelling refers to alterations in the structure of resistance vessels contributing to elevated systemic vascular resistance in hypertension. We start with some historical aspects, underscoring the importance of Folkow's contribution made half a century ago. We then move to some basic concepts on the biomechanics of blood vessels, and explicit the definitions proposed by Mulvany for specific forms of remodelling, especially inward eutrophic and inward hypertrophic. The available evidence for the existence of remodelled resistance vessels in hypertension comes next, with relatively more weight given to human, in comparison with animal data. Mechanisms are discussed. The impact of antihypertensive drug treatment on remodelling is described, again with emphasis on human data. Some details are given on the three studies to date which point to remodelling of subcutaneous resistance arteries as an independent predictor of cardiovascular risk in hypertensive patients. We terminate by considering the potential role of remodelling in the pathogenesis of end-organ damage and in the perpetuation of hypertension.
Feihl
François
F
Division de Physiopathologie Clinique, Département de Médecine, Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Rue du Bugnon 46, BH10-701, CH-1011 Lausanne, Switzerland. francois.feihl@chuv.ch
Liaudet
Lucas
L
Levy
Bernard I
BI
Waeber
Bernard
B
D000222:Adaptation, Physiological; D000818:Animals; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D006965:Hyperplasia; D006973:Hypertension / Q000188:drug therapy / Q000266:history / Q000473:pathology / Q000503:physiopathology*; D040542:Mechanotransduction, Cellular; D008833:Microcirculation / Q000503:physiopathology; D008955:Models, Cardiovascular; D013314:Stress, Mechanical; D009626:Terminology as Topic; D014655:Vascular Resistance / Q000187:drug effects
D000959:Antihypertensive Agents