Influence of Perivascular Adipose Tissue on Microcirculation: A Link Between Hypertension and Obesity

Abstract

Alterations in microcirculation play a crucial role in the pathogenesis of cardiovascular and metabolic disorders such as obesity and hypertension. The small resistance arteries of these patients show a typical remodeling, as indicated by an increase of media or total wall thickness to lumen diameter ratio that impairs organ flow reserve. The majority of blood vessels are surrounded by a fat depot which is termed perivascular adipose tissue (PVAT). In recent years, data from several studies have indicated that PVAT is an endocrine organ that can produce a variety of adipokines and cytokines, which may participate in the regulation of vascular tone, and the secretory profile varies with adipocyte phenotype and disease status. The PVAT of lean humans largely secretes the vasodilator adiponectin, which will act in a paracrine fashion to reduce peripheral resistance and improve nutrient uptake into tissues, thereby protecting against the development of hypertension and diabetes. In obesity, PVAT becomes enlarged and inflamed, and the bioavailability of adiponectin is reduced. The inevitable consequence is a rise in peripheral resistance with higher blood pressure. The interrelationship between obesity and hypertension could be explained, at least in part, by a cross-talk between microcirculation and PVAT. In this article, we propose an integrated pathophysiological approach of this relationship, in order to better clarify its role in obesity and hypertension, as the basis for effective and specific prevention and treatment.

Mechanisms of Vascular Inflammation and Potential Therapeutic Targets: A Position Paper From the ESH Working Group on Small Arteries

“…Various cardiovascular and metabolic disorders are linked with vascular inflammation, including diabetes, obesity, hypercholesterolemia, senescence, and aging, which have already been well discussed in recent publications. [30][31][32][33][34][35] In this article, we provide a current overview and concepts about inflammatory mechanisms and epigenetic modifications in the vasculature and their contribution to vascular injury associated to hypertension and neurodegenerative diseases. Finally, we synthesize current evidence to demonstrate how these pathways may represent novel therapeutic targets, offering promising avenues for the treatment of vascular disorders.…”