Importance of the Arterioles in Hypertension

Arterioles and the small arteries that are located immediately upstream from the arterioles are the major sites of vascular resistance in the peripheral circulation. Thus, changes in the structure and function of these vessels can play a crucial role in the development and maintenance of hypertension, since an elevation in peripheral vascular resistance is a common denominator in virtually all forms of this disease. In addition to controlling the resistance to blood flow in peripheral vascular beds, arterioles play a crucial role in determining the distribution of blood flow within the tissues. Therefore, changes in arteriolar structure, function, and microvessel density can have important implications for the supply of oxygen and nutrients to the tissues in hypertensive individuals. A variety of alterations in arteriolar structure and function can lead to an elevated vascular resistance in hypertension (Figure 1). These include increases in active resting tone; an enhanced response to vasoconstrictor stimuli; an impaired relaxation in response to vasodilator stimuli; a reduced number of arterioles and capillaries (microvascular rarefaction), and structural alterations leading to reduced lumen diameter, increases in wall/lumen ratio, and increases in vessel stiffness.

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