Mechanisms of cardiac fibrosis in hypertension

Abstract

Changes in the composition of cardiac tissue develop in hypertensive patients with left ventricular hypertrophy (ie, hypertensive heart disease) and lead to structural remodeling of the myocardium. One of these changes is related to the disruption of the equilibrium between the synthesis and degradation of collagen types I and III molecules, which results in an excessive accumulation of collagen types I and III fibers within the myocardium. Myocardial fibrosis is the consequence of a number of pathologic processes mediated by mechanical, neurohormonal, and cytokine routes. The clinical relevance of fibrosis is that it may contribute to heart failure and other cardiac complications in patients with hypertensive heart disease. This brief review focuses on the mechanisms of hypertensive myocardial fibrosis.

Figure 1

Endomyocardial tissue from a hypertensive patient with left ventricular hypertrophy showing perivascular fibrosis (A), microscopic scarring (B), and interstitial fibrosis (C). Sections were stained with Picrosirius red, and collagen tissue was identified in red.

Figure 2

Mosaic of factors and interactions involved in the derangement of fibrillar collagen turnover in hypertensive heart disease.