Small artery remodeling in hypertension: Can it be corrected?

Vascular structure, function, and mechanics are altered in hypertension, wh ich contributes to an important degree to complications of elevated blood p ressure. Vascular hypertrophy with collagen deposition and increased stiffn ess is found in large arteries, whereas in small arteries, smooth muscle ce lls are restructured around a smaller lumen, and there is no net growth of the vascular wall, particularly in milder forms of hyper tension. Hypertrop hic remodeling and increased small artery stiffness may be found in more se vere hypertension. Endothelial dysfunction occurs in large or smaller vesse ls in a variable percentage of patients, particularly in presence of other risk factors such as diabetes, smoking, dyslipidemia, and advanced atherosc lerosis. In clinical trials, 1-year treatment with angiotensin-converting e nzyme inhibitors, angiotensin AT(1) receptor antagonists, and long-acting c alcium channel blockers corrected small artery structure and endothelial dy sfunction in hypertensive patients, whereas beta -adrenergic receptor block ers did not. Improved outcomes in hypertensive patients demonstrated in rec ent trials with some but not others of these agents could be a consequence, at least in part, of vascular protection offered by some antihypertensive agents.