Mechanisms of Vascular Disease in Hypertension with Special Reference to Diabetes

ABSTRACT

In this article, it is proposed that the epidemiological observations regarding the measures of blood pressure and cardiovascular risk suggest that the vascular damage of hypertension is powerfully related to vessel stiffness. Several phenotypes within the hypertensive population, including salt sensitivity, central obesity, insulin resistance, and nonmodulating hypertension, cluster with vascular risk, and the features of the high-risk phenotype suggest a common antecedent characterizing the patient with the elevated cardiovascular risk associated with high blood pressure. The article also explores the relationship between blood pressure lowering and outcome, concluding that it is not yet fully understood how elevation of blood pressure increases risk or how reducing it produces benefit.

KEYWORDS

Hypertension - pulse pressure - vessel stiffness - diabetes - insulin resistance

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