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(Circulation. 2008;118:968-976.)
© 2008 American Heart Association, Inc.

Basic Science for Clinicians

Impaired Tissue Perfusion

A Pathology Common to Hypertension, Obesity, and Diabetes Mellitus

Bernard I. Levy, MD, PhD; Ernesto L. Schiffrin, MD, PhD; Jean-Jacques Mourad, MD, PhD; Denis Agostini, MD, PhD; Eric Vicaut, MD, PhD; Michel E. Safar, MD; Harry A.J. Struijker-Boudier, PhD

From Centre de Recherche Cardiovasculaire de Lariboisière, INSERM U689, Service d'Explorations Fonctionnelles, Hôpital Lariboisière (B.I.L.), Paris, France; Lady Davis Institute of Medical Research and Department of Medicine, Sir Mortimer B. Davis–Jewish General Hospital, McGill University (E.L.S.), Montreal, Quebec, Canada; Département de Médecine Interne, Hôpital Avicenne (J.-J.M.), Bobigny, France; UF Médecine Nucléaire, CHU Côte de Nacre (D.A.), Caen, France; Laboratoire d'étude de la microcirculation, Hôpital Fernand Widal (E.V.), Paris, France; Centre de Diagnostic, Hôpital Hôtel-Dieu (M.E.S.), Paris, France; and Department of Pharmacology, Cardiovascular Research Institute Maastricht (H.A.J.S.-B.), University of Limburg, Maastricht, Netherlands.

Correspondence to Professor B.I. Levy, Unité INSERM 689, Hôpital Lariboisière, 41 Blvd de la Chapelle, 75010 Paris, France. E-mail levy@larib.inserm.fr

Key Words: diabetes mellitus • hypertension • complications • microcirculation • obesity • risk factors

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
The microcirculation is generally taken to include the smallest arteries, the arterioles, capillaries, and venules.^1,2 Exchange of gases, nutrients, and metabolites between the blood and tissues occurs almost exclusively in the microcirculation, and adequate perfusion via the microcirculatory network is essential for the integrity of tissue and organ function. Our aim in the present article is to bring together recent clinical and experimental research indicating that inadequate perfusion may underlie much of the tissue and organ dysfunction associated with chronic conditions including hypertension, obesity, and diabetes mellitus. Given the high level of research activity in this field, our review can be neither systematic nor comprehensive. We apologize to the many authors whose important contributions are not acknowledged here; additional references are given in a Data Supplement on the journal’s Web site.

	Regulation of Tissue Perfusion by the Microcirculation

 
In addition to providing the large surface area needed for blood-tissue exchange, the microcirculation largely controls the perfusion of tissues in response to varying metabolic requirements. Large and medium-sized arteries and veins offer relatively little resistance to the flow of blood, and work pioneered by DeLano and colleagues³ showed that some 70% to 90% of the systemic arterial pressure is delivered to the microcirculation, where the main resistance to flow is offered. The microcirculation, therefore, largely determines local and overall peripheral resistance. The precapillary elements of the microcirculation also protect the fragile capillaries from the potentially damaging pressures that occur in the larger arteries.

	Tissue Perfusion in Hypertension

 
An abrupt increase in pressure brings about a rapid and reversible vasoconstriction of small resistance . . . [Full Text of this Article]

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