[Arterial hypertension and atherosclerosis: their epidemiology and physiopathology]

Several epidemiologic studies have demonstrated that hypertensive patients have an increased risk for the development of atherosclerosis. Although the appearance of atherosclerosis only in those parts of vascular system subjected to high blood pressure suggests that the mechanical stress is the principal factor involved in the development of atherosclerosis, the mechanisms underlying the linkage between hypertension and atherosclerosis are not yet completely understood. In fact, the evidence that antihypertensive treatments are not able to abolish the increased incidence of ischemic accidents in hypertensive patients suggests that other cellular and molecular mechanisms are involved in the pathogenesis of atherosclerosis. The pathogenesis of hypertension is a multifactorial process that involves the interaction of genetic and environmental factors which determine the abnormalities of volume regulation, the enhanced vasoconstriction and the remodeling of the arterial wall which is characterized by hypertrophy and proliferation of vascular smooth muscle cells. On the other hand, the increased growth response of vascular smooth muscle cells represents one of the principal characteristics of atherosclerosis. Thus, increased vascular smooth muscle cell growth is a common feature in the pathogenesis of both atherosclerosis and hypertension.