How Structure, Mechanics and Function of the Vasculature Contribute to Blood Pressure Elevation in Hypertension

Publication date: Available online 8 February 2020Source: Canadian Journal of CardiologyAuthor(s): Ernesto L. SchiffrinAbstractLarge conduit arteries and the microcirculation participate in the mechanisms of elevation of blood pressure (BP). Large vessels play roles predominantly in older subjects, with stiffening progressing after middle age leading to increases in systolic BP found in most humans with aging. Systolic BP elevation and increased pulsatility penetrate deeper into the distal vasculature, leading to microcirculatory injury and remodeling, and associated endothelial dysfunction. The result is target organ damage in the heart, brain and kidney. In younger individuals genetically predisposed to high BP, increased salt intake or other exogenous or endogenous risk factors for hypertension including overweight and excess alcohol intake lead to enhanced sympathetic activity and vasoconstriction. Enhanced vasoconstrictor responses and myogenic tone become persistent when embedded in an increased extracellular matrix, resulting in remodeling of resistance arteries with a narrowed lumen and increased media/lumen ratio. Stimulation of the renin-angiotensin-aldosterone and endothelin systems, and inflammatory and immune activation to which may contribute gut microbiome dysbiosis as a result of salt intake also participate in the injury and remodeling of the microcirculation and endothelial dysfunction. Inflammation of perivascular fat and loss of anticontractile factors pla...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research