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Small artery remodeling in hypertension and diabetes

Current Hypertension Reports volume 8, pages 90–95 (2006)Cite this article

Abstract

The development of structural changes in the systemic vasculature is the end result of established hypertension. In essential hypertension, small artery smooth muscle cells are restructured around a smaller lumen, and there is no net growth of the vascular wall, whereas in some secondary forms of hypertension and in non-insulindependent diabetes mellitus, a hypertrophic remodeling may be detected. Indices of small resistance artery structure, such as the tunica media to internal lumen ratio, may have a strong prognostic significance in hypertensive patients. Various antihypertensive drugs seem to have different effects on vascular structure. A complete normalization of small resistance artery structure was demonstrated in hypertensive patients, after prolonged and effective therapy with angiotensin-converting enzyme inhibitors, angiotensin II-receptor blockers, and calcium antagonists. Few data are available in diabetic hypertensive patients; however, blockade of the renin-angiotensin system seems to be effective in this regard.

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References and Recommended Reading

  1. Mulvany MJ, Aalkjaer C: Structure and function of small arteries. Physiol Rev 1990, 70:921–971.

    PubMed  CAS  Google Scholar 

  2. Mulvany MJ: Structural abnormalities of the resistance vasculature in hypertension. J Vasc Res 2003, 40:558–560.

    Article  PubMed  Google Scholar 

  3. Schiffrin EL: Remodeling of resistance arteries in essential hypertension and effects of antihypertensive treatment. Am J Hypertens 2004, 17:1192–1200. A very well-written state-of-the-art paper focused on the mechanism underlying the development of structural alterations of small arteries and on pharmacologic correction of such alterations.

    Article  PubMed  CAS  Google Scholar 

  4. Christensen KL, Mulvany MJ: Location of resistance arteries. J Vasc Res 2001, 38:1–12. This very interesting paper deals with the definition of structural alterations of small resistance arteries in relation to systemic hemodynamics.

    Article  PubMed  CAS  Google Scholar 

  5. Mulvany MJ: Small artery remodeling and significance in the development of hypertension. News Physiol Sci 2002, 17:105–109. A comprehensive review, taking into account methodologic approaches, functional consequences, and the clinical meaning of structural and functional alterations of small resistance arteries.

    PubMed  Google Scholar 

  6. Aalkjaer C, Haegerty AM, Petersen KK, et al.: Evidence for increased media thickness, increased neural amine uptake, and depressed excitation-contraction coupling in isolated resistance vessels from essential hypertensives. Circ Res 1987, 61:181–186.

    PubMed  CAS  Google Scholar 

  7. Schiffrin EL, Deng LY, Larochelle P: Morphology of resistance arteries and comparison of effects of vasoconstrictors in mild essential hypertensive patients. Clin Invest Med 1993 16:177–186.

    PubMed  CAS  Google Scholar 

  8. Agabiti-Rosei E, Rizzoni D, Castellano M, et al.: Media: lumen ratio in human small resistance arteries is related to forearm minimal vascular resistance. J Hypertens 1995, 13:341–347.

    Google Scholar 

  9. Baumbach GL, Heistad DD: Remodeling of cerebral arterioles in chronic hypertension. Hypertension 1989, 13:968–972.

    PubMed  CAS  Google Scholar 

  10. Heagerty AM, Aalkjaaer C, Bund SJ, et al.: Small artery structure in hypertension: dual process of remodeling and growth. Hypertension 1993, 21:391–397.

    PubMed  CAS  Google Scholar 

  11. Mulvany MJ, Baumbach GL, Aalkjaer C, et al.: Vascular remodeling. Hypertension 1996, 28:505–506.

    PubMed  CAS  Google Scholar 

  12. Bund SJ, Lee RMKW: Arterial structural changes in hypertension: a consideration of methodology, terminology and functional conseqences. J Vasc Res 2003, 40:547–557.

    PubMed  Google Scholar 

  13. Rizzoni D, Porteri E, Castellano M, et al.: Vascular hypertrophy and remodeling in secondary hypertension. Hypertension 1996, 28:785–790.

    PubMed  CAS  Google Scholar 

  14. Rizzoni D, Porteri E, Guel. D, et al.: Cellular hypertrophy in subcutaneous small arteries of patients with renovascular hypertension. Hypertension 2000, 35:931–935.

    PubMed  CAS  Google Scholar 

  15. McNally PG, Watt PAC, Rimmer T, et al.: Impaired contraction and endothelium-dependent relaxation in isolated resistance vessels from patients with insulin-dependent diabetes mellitus. Clin Sci 1994, 87:31–36.

    PubMed  CAS  Google Scholar 

  16. Rizzoni D, Porteri E, Guel. D, et al.: Structural alterations in subcutaneous small arteries of normotensive and hypertensive patients with non-insulin dependent diabetes mellitus. Circulation 2001, 103:1238–1244. A paper addressing in detail the structural and functional alterations in small resistance arteries taken from hypertensive and normotensive diabetic patients.

    PubMed  CAS  Google Scholar 

  17. Schofield I, Malik R, Izzard A, et al.: Vascular structural and functional changes in type 2 diabetes mellitus: evidence for the role of abnormal myogenic responsiveness and dyslipidemia. Circulation 2002, 106:3037–3043. In this manuscript, the authors propose an interesting hypothesis about the relation between the lack of myogenic response and the development of hypertrophic remodeling of subcutaneous small arteries in diabetic patients.

    Article  PubMed  Google Scholar 

  18. Lever AF: Slow pressor mechanisms in hypertension: A role for hypertrophy of resistance vessels? J Hypertens 1986, 4:515–524.

    Article  PubMed  CAS  Google Scholar 

  19. Korner PI, Bobik A, Jennings GL, et al.: Significance of cardiovascular hypertrophy in the development and maintenance of hypertension. J Cardiovasc Pharmacol 1991, 17(Suppl2):S25-S32.

    Article  PubMed  Google Scholar 

  20. Folkow B: Physiological aspects of primary hypertension. Physiol Rev 1982, 62:347–504.

    PubMed  CAS  Google Scholar 

  21. Sivertsson R: The hemodynamic importance of structural vascular changes in essential hypertension. Acta Physiol Scand 1970, 343:14–19.

    Google Scholar 

  22. Rizzoni D, Palombo C, Porteri E, et al.: Relationships between coronary vasodilator capacity and small artery remodeling in hypertensive patients. J Hypertens 2003, 21:625–632.

    Article  PubMed  CAS  Google Scholar 

  23. Park JB, Schiffrin EL: Small artery remodeling is the most prevalent (earliest?) form of target organ damage in mild essential hypertension. J Hypertens 2001, 19:921–930. Remodeling of small arteries is supposed to occur very early in the clinical history of hypertension. This may have important clinical consequences in terms of development of target organ damage.

    Article  PubMed  CAS  Google Scholar 

  24. Muiesan ML, Rizzoni D, Salvetti M, et al.: Structural changes in small resistance arteries and left ventricular geometry in patients with primary and secondary hypertension. J Hypertens 2002, 20:1439–1444.

    Article  PubMed  CAS  Google Scholar 

  25. Rizzoni D, Porteri E, Boari GEM, et al.: Prognostic significance of small artery structure in hypertension. Circulation 2003, 108:2230–2235. The first demonstration of a relevant prognostic role of structural alterations of subcutaneous small resistance arteries in a highrisk population.

    Article  PubMed  Google Scholar 

  26. Izzard AS, Rizzoni D, Agabiti-Rosei E, Heagerty AM: Small artery structure and hypertension: adaptive changes and target organ damage. J Hypertens 2005, 23:247–250. An interesting editorial focused on the pathophysiologic and clinical significance of small artery remodeling.

    Article  PubMed  CAS  Google Scholar 

  27. Sihm I, Schroeder AP, Aalkjaer C, et al.: Normalization of resistance artery structure and left ventricular morphology with a perindopril-based regimen. Can J Cardiol 1994, 10(SupplD):30D-32D.

    PubMed  Google Scholar 

  28. Thybo NK, Stephens N, Cooper A, et al.: Effect of antihypertensive treatment on small arteries of patients with previously untreated essential hypertension. Hypertension 1995, 25(Pt_1):474–481.

    PubMed  CAS  Google Scholar 

  29. Schiffrin EL, Deng LY, Larochelle P: Effects of a betablocker or a converting enzyme inhibitor on resistance arteries in essential hypertension. Hypertension 1994, 23:83–91.

    PubMed  CAS  Google Scholar 

  30. Schiffrin EL, Deng LY, Larochelle P: Progressive improvement in the structure of resistance arteries of hypertensive patients after 2 years of treatment with an angiotensin I-converting enzyme inhibitor. Comparison with effects of a beta-blocker. Am J Hypertens 1995, 8:229–236.

    Article  PubMed  CAS  Google Scholar 

  31. Rizzoni D, Muiesan ML, Porteri E, et al.: Effect of longterm antihypertensive treatment with lisinopril on resistance arteries in hypertensive patients with left ventricular hypertrophy. J Hypertens 1997, 15:197–204.

    Article  PubMed  CAS  Google Scholar 

  32. Schiffrin EL, Deng LY: Structure and function of resistance arteries of hypertensive patients treated with a beta blocker or a calcium channel antagonist. J Hypertens 1996, 14:1237–1244.

    Article  Google Scholar 

  33. Sihm I, Schroeder AP, Aalkjaer C, et al.: Effect of antihypertensive treatment on cardiac and subcutaneous artery structure: a comparison between calcium channel blocker and thiazide-based regimens. Am J Hypertens 1998, 11:263–271.

    Article  PubMed  CAS  Google Scholar 

  34. Schiffrin EL, Park JB, Integan HD, Toyuz RM: Correction of arterial structure and endothelial dysfunction in human essential hypertension by the angiotensin receptor antagonists losartan. Circulation 2000, 101:1653–1659.

    PubMed  CAS  Google Scholar 

  35. Schiffrin EL, Park JB, Pu Q: Effect of crossing over hypertensive patients from a beta-blocker to an angiotensin receptor antagonist on resistance artery structure and on endothelial function. J Hypertens 2002, 20:71–78.

    Article  PubMed  CAS  Google Scholar 

  36. Guidelines Committee: 2003 European Society of Hypertension -European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003, 21:1011–1053.

    Article  Google Scholar 

  37. Endemann DH, Pu Q, De Ciuceis C, et al.: Persistent remodeling of resistance arteries in type 2 diabetic patients on antihypertensive treatment. Hypertension 2004, 43:399–404.

    Article  PubMed  CAS  Google Scholar 

  38. Rizzoni D, Porteri E, De Ciuceis C, et al.: Effect of treatment with candesartan or enalapril on subcutaneous small artery structure in hypertensive patients with non insulin-dependent diabetes mellitus. Hypertension 2005, 45:659–665.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Medical and Surgical Sciences, University of Brescia, c/o 2a Medicina Spedali Civili di Brescia, Piazza Spedali Civili 1, 25100, Brescia, Italy

    Damiano Rizzoni MD

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  1. Damiano Rizzoni MD
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  2. Enrico Agabiti Rosei MD
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Correspondence to Damiano Rizzoni MD.

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Rizzoni, D., Rosei, E.A. Small artery remodeling in hypertension and diabetes. Current Science Inc 8, 90–95 (2006). https://doi.org/10.1007/s11906-006-0046-3

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  • DOI: https://doi.org/10.1007/s11906-006-0046-3

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