Vascular remodeling, macro- and microvessels: therapeutic implications.
Macrovasculature and microvasculature are deeply interrelated, since microvascular structure is not only the site of vascular resistance but probably also the origin of most of the wave reflections generating increased central systolic blood pressure. In fact, preliminary data suggest that some index of large artery stiffness is related with the media to lumen ratio of subcutaneous small resistance arteries of hypertensive patients. Microvascular structural alterations and changes in the mechanical properties of the macrovessels represent potent predictors of prognosis. Hypertension-related damage to the micro- and macrovascular system may be corrected by pharmacological agents. Among them, beta-blocking agents and diuretics have a negligible effect on microvascular structure, while renin-angiotensin system antagonists and calcium entry blockers have favorable actions, improving large artery mechanics and possibly reducing central wave reflections.
Rizzoni
Damiano
D
Clinica Medica, Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy. rizzoni@med.unibs.it
Muiesan
Maria Lorenza
ML
Porteri
Enzo
E
De Ciuceis
Carolina
C
Boari
Gianluca E M
GE
Salvetti
Massimo
M
Paini
Anna
A
Rosei
Enrico Agabiti
EA
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001808:Blood Vessels / Q000473:pathology / Q000503:physiopathology; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D014655:Vascular Resistance
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers