Aortic Remodeling in Patients with Arterial Hypertension: Pathophysiological Mechanisms, Therapeutic Interventions and Preventive Strategies-A Position Paper from the Heart and Hypertension Working Group of the Italian Society of Hypertension.

Federica Piani, Riccardo Schiavon, Rosa Curcio, Chiara Tognola, Giuliano Tocci, Sebastiano Cicco, Marialuisa Sveva Marozzi, Massimo Volpe, Michele Ciccarelli, Antonietta Gigante, Claudia Agabiti-Rosei, Alberto Milan, Christian Basile, Chiara Cogliati, Giacomo Pucci, Costantino Mancusi, Valeria Visco, Carlo Palombo, Maria Lorenza Muiesan, Maria Lembo, Ilaria Fucile, Massimo Salvetti, Alessandro Maloberti, Nicola De Luca, Dario Leone, Giacomo Buso

Journal: High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension 2025;32(3):255-273

PMID: 40082374

Abstract

In patient with arterial hypertension the whole aorta is exposed to increased wall stress due to pressure overload. Different blood pressure (BP) components have been reported as main determinant of aortic remodelling. In particular increased diastolic BP has been associated with aortic dilatation across all its segments with smaller increase in aortic root and ascending aorta related to increased systolic BP and pulse pressure. Optimal BP control is crucial to prevent development of aortic aneurysm and acute aortic disease. Many studies have evaluated the role of different antihypertensive drug classes for prevention of adverse aortic remodelling including beneficial effects of ACEIs, ARBs, dihydropyridinic calcium channel blockers and Beta-blockers. The present review discusses pathophysiological mechanisms, therapeutic interventions and preventive strategies for development of aortic remodeling in patients with arterial hypertension.

© 2025. The Author(s).

Address: Department of Advanced Biomedical Science, Hypertension Research Center, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy. [email protected].; Department of Advanced Biomedical Science, Hypertension Research Center, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.; Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy.; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.; Division of Internal Medicine, ASST Spedali Civili Brescia, Brescia, Italy.; Centro per lo Studio dell'Ipertensione Arteriosa e Fattori di Rischio Cardiovascolari, Brescia, Italy.; Cardiovascular Research Unit, Department of Medicine and Surgery, University of Salerno, Via Salvador Allende, 84081, Baronissi, Italy.; Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.; Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy.; School of Medicine and surgery, University of Milano-Bicocca, Milan, Italy.; Cardiology 4, "A.De Gasperis" Cardio Center, ASST GOM Niguarda Ca' Granda, Milan, Italy.; Unit of Internal and Traslational Medicine, Terni University Hospital, Terni, Italy.; Department of Medicine and Surgery, University of Perugia, Perugia, Italy.; Unit of Internal Medicine, Terni University Hospital, Terni, Italy.; Unit of Internal Medicine "Guido Baccelli" and Unit of Hypertension "Anna Maria Pirrelli", Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of Bari Aldo Moro, AUOC Policlinico di Bari, Bari, Italy.; Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40138, Bologna, Italy.; Division of Internal Medicine, Candiolo Cancer Institute FPO- IRCCS, Candiolo, TO, Italy.; Department of Medical Sciences, University of Turin, Turin, Italy.; Department of Biomedical and Clinical Sciences, University of Milan and Internal Medicine, L.Sacco Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy.; Internal Medicine, L.Sacco Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy.; Department of Clinical and Experimental Sciences, University of Brescia & ASST Spedali Civili di Brescia, Brescia, Italy.; IRCCS San Raffaele Roma, Rome, Italy.; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.; Division of Internal Medicine, ASST Spedali Civili Brescia, Brescia, Italy.; Centro per lo Studio dell'Ipertensione Arteriosa e Fattori di Rischio Cardiovascolari, Brescia, Italy.; Cardiovascular Research Unit, Department of Medicine and Surgery, University of Salerno, Via Salvador Allende, 84081, Baronissi, Italy.
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