Vascular Remodeling

Vascular remodeling is characterized by the structural modifications of large and small arteries causing alteration of lumen size and change in diameter. Essential hypertension is characterized by increased peripheral vascular resistance to blood flow, which occurs generally as a result of energy dissipation in small arteries and arterioles which undergo vascular remodeling, particularly in younger individuals. The vascular phenotype of hypertension varies according to the age of subjects. In younger individuals with elevated blood pressure, vascular remodeling occurs mainly in small resistance arteries, which contributes to the increase of peripheral resistance. As blood pressure remains elevated for a prolonged time, vascular changes occur predominantly in large conduit arteries, such as the aorta, which becomes stiffer. The mechanical effects of blood pressure and shear stress in the vasculature, as well as the action of hormonal systems such as the renin-angiotensin-aldosterone system, endothelins, catecholamines, agents generated in perivascular fat, inflammatory mediators, such as different cytokines and chemokines, as well as immune mediators, such as lymphocytes and macrophages and their products, are key elements in the pathophysiology of vascular remodeling as well as of the vascular complication of hypertension.