Abstract

It has been postulated that changes in vessel structure have an important role in the pathogenesis of essential hypertension. Despite the potential pathogenetic importance of vascular remodeling, the molecular basis of this process remains poorly characterized. A rapidly emerging body of evidence indicates that many of the processes responsible for remodeling the vasculature are mediated by complex interactions between autocrine-paracrine factors generated within the vessel wall. Indeed, at the level of a single vessel the overall vessel structure appears to be determined by a yin-yang balance of stimulatory and inhibitory factors that module cell growth, death, migration and extracellular matrix composition. There is increasing evidence that factors that regulate vessel tone are also important determinants of vessel structure. This review focuses on angiotensin II as a paradigmatic vasoactive substance capable of mediating the process of vascular remodeling which is predominantly associated with vascular hypertrophy in hypertension. The pathogenetic and clinical implications of understanding these autocrine-paracrine systems are discussed.