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(Hypertension. 2008;51:177.)
© 2008 American Heart Association, Inc.

Editorial Commentaries

Vascular Stiffness and the "Chicken-or-the-Egg" Question

Stephen P. Glasser; Donna K. Arnett

From the Division of Preventive Medicine (S.P.G.), Department of Medicine, and Department of Epidemiology (D.K.A.), University of Alabama at Birmingham.

Correspondence to Stephen P. Glasser, Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Ave S, Birmingham, AL 35216. E-mail sglasser@uab.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Although the incidence of hypertension approaches 90% for people over the age of 70 years, the etiology of hypertension remains elusive for the vast majority. The complications of long-standing hypertension are well known and relate to arterial disease with clinical manifestations in the heart, brain, and kidney. However, the paradigm of elevated blood pressure resulting in vasculopathy continues to be challenged. Rather than hypertension resulting in altered vascular structure and function, it seems that changes in vascular integrity (structure) precede and may be causal in the development of elevated blood pressure with resultant hypertension that ultimately leads to clinical events (Figure). Alterations in cardiovascular structure and function that have been shown to precede the finding of elevated blood pressure include the occurrence of left ventricular hypertrophy in children and young adults of hypertensive parents¹ (although one cannot rule out the role of blood pressure in causing cardiovascular remodeling in studies where only resting, occasional measurements of blood pressure are made), diastolic filling abnormalities in normotensive individuals predisposed to hypertension,² endothelial dysfunction as a precursor to the finding of hypertension,³ and increased arterial stiffness in normotensive subjects predisposed to develop hypertension.⁴ Recently it has been reported that, in confirmed prehypertensive subjects, intimal-medial thickness is increased in the common carotid artery when compared with subjects who remain normotensive.⁵ In addition, Lackland⁶ has demonstrated an association between low birth weight and the subsequent development of hypertension, with the greatest risk of hypertension occurring among those with low birth weight and accelerated . . . [Full Text of this Article]

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				S. P. Glasser, J. N. Basile, and D. T. Lackland Does Prehypertension Represent an Increased Risk for Incident Hypertension and Adverse Cardiovascular Outcome? Hypertension, November 1, 2009; 54(5): 954 - 955. [Full Text] [PDF]