Structural changes of large conduit arteries in hypertension

BACKGROUND: Structural alterations of large conduit arteries are a common pathway for any complication of hypertensive vascular disease. Whether increased arterial wall thickness occurs at an early phase in uncomplicated hypertension has remained largely ignored until recent years. METHODS: Sophisticated echo-Doppler techniques with a high degree of resolution and reproducibility have been developed to obtain reliable non-invasive determinations of intima-media thickness of superficial arteries such as the radial and the common carotid arteries. RESULTS: In uncomplicated hypertension, a significant increase in intima-media thickness is observed at the sites both of the radial and of the carotid arteries. The former is known to be constantly undamaged by atheroscierosis and is composed almost exclusively of arterial smooth muscle; operational arterial stiffness is found to be normal. The latter is strongly affected by atheroscierosis and predominantly composed of elastin and collagen fibres; operational arterial stiffness is found to be increased. In old subjects with systolic hypertension, radial artery hypertrophy is significantly reversed by drug therapy involving diuretics, converting enzyme inhibitors or both. This change occurs in parallel with the reduction in blood pressure. CONCLUSION: In sustained essential hypertension, arterial wall hypertrophy can be demonstrated in the absence of organ damage. Operational arterial elasticity is maintained in peripheral but not in central arteries. Structural changes of the large conduit arteries are substantially reversed by drug therapy together with a reduction in blood pressure.