Long-term structural changes in human hypertensive vessels.

Indirect assessments of the haemodynamics of the circulation in human essential hypertension demonstrate that when the disease is established there is an increase in peripheral vascular resistance and a normal cardiac output. The resistance to blood flow is maintained by an adaptive alteration in the geometry of precapillary vessels which is brought about as a result of the pressure excess; the change is manifested as an increased wall-to-lumen ratio. How this is achieved is the subject of intense research at this time, but in addition, there is some controversy as to the exact nature of the cellular alterations to the vascular architecture at the level of the resistance artery. The purpose of this work is to address problems that have arisen in trying to solve this question, and to identify therapeutic implications for future management of hypertension, and for reducing the number of cardiac events.