Hypertension and the arterial system: clinical and therapeutic aspects.

There is very clear evidence that active changes in the arterial wall contribute substantially to the pathophysiology, prognosis and treatment of hypertension. Reduced aortic compliance independently affects the blood pressure through an increase in systolic pressure and a decrease in diastolic pressure at any given mean arterial pressure. With the subsequent increase in pulse pressure, arterial abnormalities may specifically influence cardiac morbidity and mortality, in particular by triggering coronary ischemic accidents. The pathophysiological and epidemiological results of these mechanisms clearly indicate that a severe decrease in diastolic blood pressure might precede some hypertensive coronary ischemic accidents.