Aortic Remodeling in Patients with Arterial Hypertension: Pathophysiological Mechanisms, Therapeutic Interventions and Preventive Strategies—A Position Paper from the Heart and Hypertension Working Group of the Italian Society of Hypertension
Costantino Mancusi, Christian Basile, Ilaria Fucile, Carlo Palombo, Maria Lembo, Giacomo Buso, Claudia Agabiti-Rosei, Valeria Visco, Antonietta Gigante, Giuliano Tocci, Alessandro Maloberti, Chiara Tognola, Giacomo Pucci, Rosa Curcio, Sebastiano Cicco, Federica Piani, Marialuisa Sveva Marozzi, Alberto Milan, Dario Leone, Chiara Cogliati, Riccardo Schiavon, Massimo Salvetti, Michele Ciccarelli, Nicola De Luca, Massimo Volpe, María Lorenza Muiesan
Abstract
In patient with arterial hypertension the whole aorta is exposed to increased wall stress due to pressure overload. Different blood pressure (BP) components have been reported as main determinant of aortic remodelling. In particular increased diastolic BP has been associated with aortic dilatation across all its segments with smaller increase in aortic root and ascending aorta related to increased systolic BP and pulse pressure. Optimal BP control is crucial to prevent development of aortic aneurysm and acute aortic disease. Many studies have evaluated the role of different antihypertensive drug classes for prevention of adverse aortic remodelling including beneficial effects of ACEIs, ARBs, dihydropyridinic calcium channel blockers and Beta-blockers. The present review discusses pathophysiological mechanisms, therapeutic interventions and preventive strategies for development of aortic remodeling in patients with arterial hypertension.