Hypertensive arteriosclerotic cardiovascular disease
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Hypertensive Arteriosclerotic Cardiovascular Disease: An Overview
Introduction to Hypertensive Arteriosclerotic Cardiovascular Disease
Hypertensive arteriosclerotic cardiovascular disease (HACVD) is a complex condition characterized by the interplay between high blood pressure (hypertension) and arteriosclerosis, leading to significant cardiovascular complications. This article synthesizes recent research findings to provide a comprehensive understanding of HACVD, its risk factors, and its impact on health.
Hypertension and Its Role in Cardiovascular Disease
Mechanical Stress and Vascular Damage
Hypertension is a major contributor to various cardiovascular diseases, including coronary heart disease, stroke, and congestive heart failure. The elevated blood pressure exerts mechanical stress on the heart and blood vessels, leading to hypertensive heart disease and vascular damage. This stress results in fibromuscular thickening and luminal narrowing of arteries, which accelerates atherosclerosis, particularly in coronary and cerebral vessels.
Blood Pressure Control and Cardiovascular Risk
Effective blood pressure control is crucial in managing hypertensive patients. A study among Chinese community hypertensive patients revealed that only 16.34% achieved intensive BP control (SBP < 130 mmHg and DBP < 80 mmHg), while 50.25% met the standard threshold (SBP < 140 mmHg and DBP < 90 mmHg). Notably, nearly a quarter of these patients had a high 10-year risk of arteriosclerotic cardiovascular disease (ASCVD). This underscores the importance of comprehensive risk assessment beyond mere BP control.
Arteriosclerosis and Atherosclerosis in Hypertensive Patients
Vascular Abnormalities and Target Organ Damage
Arteriosclerosis (ARS) and atherosclerosis (ATS) often coexist in hypertensive patients, leading to target organ damage (TOD). Research indicates that left ventricular diastolic dysfunction (LVDD) is significantly associated with ATS but not with ARS. This suggests that while both conditions contribute to cardiovascular risk, ATS has a more direct impact on heart function .
Structural and Functional Changes in Large Arteries
Hypertension induces structural changes in large arteries, characterized by arterial stiffening and increased systolic and pulse pressure. These changes lead to left ventricular hypertrophy, altered coronary perfusion, and decreased perfusion reserve during stress. The imbalance between pro-angiogenic and anti-angiogenic factors in hypertensive patients further exacerbates vascular damage and inflammation.
Epidemiological Insights and Socioeconomic Factors
Mortality Rates and Population Distribution
Mortality rates from arteriosclerotic heart disease vary significantly across different regions and states in the United States, often correlating with population density and urbanization. Higher mortality rates are observed in states with greater urban populations and higher income per capita, suggesting that lifestyle factors play a crucial role in the etiology of arteriosclerotic heart disease.
Hemodynamic Arteriosclerotic Syndrome
The concept of hemodynamic arteriosclerotic syndrome (HATS) highlights the vicious cycle of blood pressure variability and vascular disease. This syndrome encompasses both atherosclerosis and arteriosclerosis, with the former driven by metabolic risk factors and the latter by aging and hypertension.
Conclusion
Hypertensive arteriosclerotic cardiovascular disease is a multifaceted condition influenced by mechanical stress, vascular abnormalities, and socioeconomic factors. Effective management requires comprehensive risk assessment, beyond simple blood pressure control, to address the underlying vascular changes and prevent target organ damage. Further research is needed to develop targeted therapeutic interventions that can mitigate the impact of both arteriosclerosis and atherosclerosis in hypertensive patients.
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