Microcirculation in Hypertension: A Therapeutic Target to Prevent Cardiovascular Disease?
Arterial hypertension is a common condition worldwide and an important risk factor for cardio- and cerebrovascular events, renal diseases, as well as microvascular eye diseases. Established hypertension leads to the chronic vasoconstriction of small arteries as well as to a decreased lumen diameter...
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| Format: | Article |
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MDPI AG
2023-07-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/15/4892 |
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| author | Damiano Rizzoni Claudia Agabiti-Rosei Gianluca E. M. Boari Maria Lorenza Muiesan Carolina De Ciuceis |
| author_facet | Damiano Rizzoni Claudia Agabiti-Rosei Gianluca E. M. Boari Maria Lorenza Muiesan Carolina De Ciuceis |
| author_sort | Damiano Rizzoni |
| collection | DOAJ |
| description | Arterial hypertension is a common condition worldwide and an important risk factor for cardio- and cerebrovascular events, renal diseases, as well as microvascular eye diseases. Established hypertension leads to the chronic vasoconstriction of small arteries as well as to a decreased lumen diameter and the thickening of the arterial media or wall with a consequent increased media-to-lumen ratio (MLR) or wall-to-lumen ratio (WLR). This process, defined as vascular remodeling, was firstly demonstrated in small resistance arteries isolated from subcutaneous biopsies and measured by micromyography, and this is still considered the gold-standard method for the assessment of structural alterations in small resistance arteries; however, microvascular remodeling seems to represent a generalized phenomenon. An increased MLR may impair the organ flow reserve, playing a crucial role in the maintenance and, probably, also in the progressive worsening of hypertensive disease, as well as in the development of hypertension-mediated organ damage and related cardiovascular events, thus possessing a relevant prognostic relevance. New non-invasive techniques, such as scanning laser Doppler flowmetry or adaptive optics, are presently under development, focusing mainly on the evaluation of WLR in retinal arterioles; recently, also retinal microvascular WLR was demonstrated to have a prognostic impact in terms of cardio- and cerebrovascular events. A rarefaction of the capillary network has also been reported in hypertension, which may contribute to flow reduction in and impairment of oxygen delivery to different tissues. These microvascular alterations seem to represent an early step in hypertension-mediated organ damage since they might contribute to microvascular angina, stroke, and renal dysfunction. In addition, they can be markers useful in monitoring the beneficial effects of antihypertensive treatment. Additionally, conductance arteries may be affected by a remodeling process in hypertension, and an interrelationship is present in the structural changes in small and large conductance arteries. The review addresses the possible relations between structural microvascular alterations and hypertension-mediated organ damage, and their potential improvement with antihypertensive treatment. |
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| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T00:24:16Z |
| publishDate | 2023-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-487754316d7441de97d947a6b2f07dbe2023-11-18T23:06:37ZengMDPI AGJournal of Clinical Medicine2077-03832023-07-011215489210.3390/jcm12154892Microcirculation in Hypertension: A Therapeutic Target to Prevent Cardiovascular Disease?Damiano Rizzoni0Claudia Agabiti-Rosei1Gianluca E. M. Boari2Maria Lorenza Muiesan3Carolina De Ciuceis4Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, ItalyDepartment of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, ItalyDivision of Medicine, Spedali Civili di Brescia, Montichiari, 25123 Brescia, ItalyDepartment of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, ItalyDepartment of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, ItalyArterial hypertension is a common condition worldwide and an important risk factor for cardio- and cerebrovascular events, renal diseases, as well as microvascular eye diseases. Established hypertension leads to the chronic vasoconstriction of small arteries as well as to a decreased lumen diameter and the thickening of the arterial media or wall with a consequent increased media-to-lumen ratio (MLR) or wall-to-lumen ratio (WLR). This process, defined as vascular remodeling, was firstly demonstrated in small resistance arteries isolated from subcutaneous biopsies and measured by micromyography, and this is still considered the gold-standard method for the assessment of structural alterations in small resistance arteries; however, microvascular remodeling seems to represent a generalized phenomenon. An increased MLR may impair the organ flow reserve, playing a crucial role in the maintenance and, probably, also in the progressive worsening of hypertensive disease, as well as in the development of hypertension-mediated organ damage and related cardiovascular events, thus possessing a relevant prognostic relevance. New non-invasive techniques, such as scanning laser Doppler flowmetry or adaptive optics, are presently under development, focusing mainly on the evaluation of WLR in retinal arterioles; recently, also retinal microvascular WLR was demonstrated to have a prognostic impact in terms of cardio- and cerebrovascular events. A rarefaction of the capillary network has also been reported in hypertension, which may contribute to flow reduction in and impairment of oxygen delivery to different tissues. These microvascular alterations seem to represent an early step in hypertension-mediated organ damage since they might contribute to microvascular angina, stroke, and renal dysfunction. In addition, they can be markers useful in monitoring the beneficial effects of antihypertensive treatment. Additionally, conductance arteries may be affected by a remodeling process in hypertension, and an interrelationship is present in the structural changes in small and large conductance arteries. The review addresses the possible relations between structural microvascular alterations and hypertension-mediated organ damage, and their potential improvement with antihypertensive treatment.https://www.mdpi.com/2077-0383/12/15/4892microcirculationperipheral circulationremodelingsmall resistance arteriesvascular biology |
| spellingShingle | Damiano Rizzoni Claudia Agabiti-Rosei Gianluca E. M. Boari Maria Lorenza Muiesan Carolina De Ciuceis Microcirculation in Hypertension: A Therapeutic Target to Prevent Cardiovascular Disease? Journal of Clinical Medicine microcirculation peripheral circulation remodeling small resistance arteries vascular biology |
| title | Microcirculation in Hypertension: A Therapeutic Target to Prevent Cardiovascular Disease? |
| title_full | Microcirculation in Hypertension: A Therapeutic Target to Prevent Cardiovascular Disease? |
| title_fullStr | Microcirculation in Hypertension: A Therapeutic Target to Prevent Cardiovascular Disease? |
| title_full_unstemmed | Microcirculation in Hypertension: A Therapeutic Target to Prevent Cardiovascular Disease? |
| title_short | Microcirculation in Hypertension: A Therapeutic Target to Prevent Cardiovascular Disease? |
| title_sort | microcirculation in hypertension a therapeutic target to prevent cardiovascular disease |
| topic | microcirculation peripheral circulation remodeling small resistance arteries vascular biology |
| url | https://www.mdpi.com/2077-0383/12/15/4892 |
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