Modeling mechano-driven and immuno-mediated aortic maladaptation in hypertension.

Uncontrolled hypertension is a primary risk factor for diverse cardiovascular diseases and thus remains responsible for significant morbidity and mortality. Hypertension leads to marked changes in the composition, structure, properties, and function of central arteries; hence, there has long been interest in quantifying the associated wall mechanics. Indeed, over the past 20 years there has been increasing interest in formulating mathematical models of the evolving geometry and biomechanical behavior of central arteries that occur during hypertension. In this paper, we introduce a new mathematical model of growth (changes in mass) and remodeling (changes in microstructure) of the aortic wall for an animal model of induced hypertension that exhibits both mechano-driven and immuno-mediated matrix turnover. In particular, we present a bilayered model of the aortic wall to account for differences in medial versus adventitial growth and remodeling and we include mechanical stress and inflammatory cell density as determinants of matrix turnover. Using this approach, we can capture results from a recent report of adventitial fibrosis that resulted in marked aortic maladaptation in hypertension. We submit that this model can also be used to identify novel hypotheses to guide future experimentation.