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Hypertensive Vasculopathy

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PanVascular Medicine

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Abstract

Essential hypertension is characterized by an increase in total peripheral vascular resistance, due primarily to a decrease in lumen diameter and an increase in media thickness. Underlying these phenomena are altered vascular tone (decreased relaxation and/or increased contraction) and structural remodeling. Endothelial dysfunction and arterial remodeling characterize the vascular phenotype of hypertension, known as “hypertensive vasculopathy.” Initial factors contributing to vasculopathy of hypertension involve increased transmural pressure, changes in blood flow, impaired endothelial function, and altered vascular smooth muscle cell (VSMC) contractility. More chronic changes are associated with perturbed VSMC growth, migration, differentiation, calcification and inflammation, and production of extracellular matrix proteins, responsible for structural remodeling. At the level of the vascular cells, receptors are activated by vasoactive agents and mechanical forces triggering intracellular signaling pathways and generation of reactive oxygen species (ROS). These subcellular events underlie VSMC dedifferentiation, realignment, calcification, and growth and stimulate inflammation, fibrosis, and osteogenic transformation, which contribute to endothelial dysfunction and thickening of the vascular wall. Such changes play a major role in the vasculopathy of hypertension.

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Abbreviations

Biomarker:

The National Institutes of Health Biomarkers Definitions Working Group 2001, defined a “biomarker” as a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention. In hypertension, measurement of circulating endothelial-derived molecules or cell fractions may be indicative of the state of endothelial/vascular function.

Endothelium:

The cell layer that lines blood vessels and which is at the interface between blood and the vascular wall.

Hypertensive vasculopathy:

Disorder of blood vessels associated with hypertension and characterized by endothelial dysfunction vascular remodeling, and inflammation.

Oxidative stress:

A disturbance in the balance between the production of reactive oxygen species (free radicals) and the antioxidant defenses resulting in an increased bioavailability of reactive oxygen species.

Signal transduction:

A molecular process involving the conversion of a signal from outside the cell to a functional response within the cell. For example in the vasculature, angiotensin II binds to its receptor on the vascular smooth muscle cell membrane causing a change in second messengers, such as calcium, leading to a change in cell function, such as contraction.

Vascular media:

The muscular wall of vessels composed of smooth muscle cells.

Vascular remodeling:

Changes in the structure of the vascular wall usually associated with a change in lumen diameter.

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Acknowledgments

Work from the author’s laboratory was supported by grants 44018 and 57886 from the Canadian Institutes of Health Research (CIHR) and grants from the British Heart Foundation (BHF). RMT is supported through a BHF Chair and ACM is supported through a Leadership Fellowship from the University of Glasgow.

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  1. Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, G12 8TA, Glasgow, UK

    Prof. Rhian M. Touyz M.D., Ph.D., MBBCh, FRCP, FRSE (British Heart Foundation Chair of Cardiovascular Medicine, Director – Institute of Cardiovascular & Medical Sciences) & Dr. Augusto C. Montezano Ph.D.

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  1. Prof. Rhian M. Touyz M.D., Ph.D., MBBCh, FRCP, FRSE
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  2. Dr. Augusto C. Montezano Ph.D.
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Correspondence to Rhian M. Touyz M.D., Ph.D., MBBCh, FRCP, FRSE .

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  1. Akademisches Lehrkrankenhaus MLU, Bitterfeld-Wolfen, Germany

    Peter Lanzer

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Touyz, R.M., Montezano, A.C. (2014). Hypertensive Vasculopathy. In: Lanzer, P. (eds) PanVascular Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-37393-0_51-1

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