(Circulation. 2001;104:735.)
© 2001 American Heart Association, Inc.
Current Perspectives |
Microcirculation in Hypertension
A New Target for Treatment?
From INSERM Unit 141, IFR Circulation, Hôpital Lariboisière, Paris, France (B.I.L.); Division of Cardiology, University of Perugia, Perugia, Italy (G.A.); Department of Physiology, Freie Universität Berlin, Germany (A.R.P.); and Cardiovascular Research Institute Maastricht, Universiteit Maastricht, the Netherlands (H.A.J.S.-B.).
Correspondence to H.A.J. Struijker-Boudier, Cardiovascular Research Institute Maastricht (CARIM), Universiteit Maastricht, PO Box 616, 6200 MD, Maastricht, Netherlands. E-mail hsb@carim.unimaas.nl
Key Words: microcirculation • hypertension • vessels • capillaries • angiogenesis
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Introduction |
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The number of effective agents available for the treatment of hypertension is now substantial. However, in spite of this, most would agree that there is still considerable scope for improvement in the way hypertension is managed. In many countries, the great majority of hypertensive subjects still show imperfect blood pressure control.1 Furthermore, the reductions or improvements in end-organ damage seen during antihypertensive therapy do not always correlate well with the reduction in arterial blood pressure achieved. Thus, there seems to be a need for new therapeutic perspectives in the treatment of hypertension. One important new perspective might be provided by an enhanced appreciation of the importance of the microcirculation in the pathophysiology and treatment of hypertension.
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Description of the Microcirculation |
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The microcirculation is widely taken to encompass vessels <150 µm in diameter. It therefore includes arterioles, capillaries, and venules. However, there is no universally accepted definition of the microcirculation, and it is not clear whether vessels that would be defined as small arteries on the basis of anatomical criteria but have diameters >150 µm should also be included. A definition based on arterial vessel physiology rather than diameter or structure is therefore proposed, depending on the response of the isolated vessel to increased internal pressure. By this definition, all those arterial vessels that respond to increasing pressure by a myogenic reduction in lumen diameter would be included in the microcirculation, as well as the capillaries and venules. Such a definition would include the smallest arteries and arterioles in the microcirculation and would be in
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