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New Insights Into Mechanisms Associated With Angiotensin II-Induced Vascular Hypertrophy and Remodeling.

See related article, pp 623–629 

Vascular structure plays an important role in maintaining vessel integrity and tissue perfusion in the face of changes in arterial pressure, such as that associated with chronic hypertension. Vascular hypertrophy and vascular remodeling are often used interchangeably, yet erroneously, to describe the morphological changes that occur in blood vessels in response to vascular injury or disease. Vascular hypertrophy and vascular remodeling are 2 very distinct yet related processes.1

Vascular hypertrophy is defined as an increase in vessel wall thickness measured as an increase in medial cross-sectional area (CSA), often most reflective of increases in smooth muscle cell size. Hyperplasia (increases in cell number) can also result in increases in CSA of blood vessels; however, hyperplasia is more commonly associated with proliferative diseases, such as atherosclerosis and vascular injury. Hypertrophy and hyperplasia should also not be used interchangeably as these cellular processes are also distinct.

Vascular remodeling, however, is defined as a change in inner and external diameter of a maximally dilated blood vessel measured under physiological pressure. Vascular remodeling is reported as the ratio of medial wall thickness to luminal diameter. Remodeling of blood vessels can be further classified as either inward or outward depending on the encroachment or withdrawal of vascular tissue on or from the vascular lumen, respectively. For example, inward hypertrophic remodeling is observed in resistance vessels in hypertension.

It is important to note that remodeling of blood vessels does not always involve hypertrophy. For example, remodeling of blood vessels (ie, migration of vascular muscle and extensive restructuring of the extracellular matrix) can occur without changes in vascular content in what is referred to as inward eutrophic remodeling. This example highlights the importance of why the terms vascular …