Mecanismos asociados al remodelado vascular

RENNA NF

Buenos Aires. Argentina

Conferencia; XV Congreso Argentino de Hipertensión Arterial; 2008

Sociedad Argentina de Hipertensión Arterial

Arteries are capable of modifying their structure and function in response to changes in haemodinamic conditions.  This remodeling is characterized by hypertrophy of the wall and reduction in the L/M ratio, mediated by the synthesis and release of vasoactive and growth factors, which is associated to decreased arterial distensibility. Folkow et al (59) suggested that vascular remodeling is caused by sustained arterial hypertension, and this mechanism reinforces or secondary maintains hypertension.  Other authors as Fever et al (60) suggested that in some cases, the vascular hypertrophy mechanism is primary, leading to increased peripheral resistence, and consequently to hypertension. In the vascular remodeling of metabolix syndrome both hypothesis could co-exist: increased cascade of growth factors, product of  insulin resistance and inflammation, added to hypertrophy caused by sustained hypertension. Increased superoxide production in this pathology, evident by the increased lipidic peroxidation, can activate redox sensitive genes.  Among them, the NF-kB can be found, which when parting the cytoplasmatic I-kB binding, this fraction migrates to the nucleus to bind to specific promoting zones.  Therefore, this phenomenon could be associated with the increased expression of adhesion molecules, such as VCAM-1, which is also confirmed in animal models.  In addition, as described in the literature for other experimental models, an increase was found in the expression of inflammatory molecules in the vascular wall of resistance arteries which would participate in the process of vascular remodeling.  The potential importance of the vascular wall inflammation as a therapeutic objective continues to be an area that has not been exhaustively explored, where the new developments on the participation of the inflammatory mediators in vascular remodeling could be relevant.