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Review
. 2025 May;32(3):255-273.
doi: 10.1007/s40292-025-00710-3. Epub 2025 Mar 14.

Aortic Remodeling in Patients with Arterial Hypertension: Pathophysiological Mechanisms, Therapeutic Interventions and Preventive Strategies-A Position Paper from the Heart and Hypertension Working Group of the Italian Society of Hypertension

Costantino Mancusi  1 , Christian Basile  2 , Ilaria Fucile  2 , Carlo Palombo  3 , Maria Lembo  2 , Giacomo Buso  4   5   6 , Claudia Agabiti-Rosei  4   5   6 , Valeria Visco  7 , Antonietta Gigante  8 , Giuliano Tocci  9 , Alessandro Maloberti  10   11 , Chiara Tognola  10   11 , Giacomo Pucci  12   13 , Rosa Curcio  14 , Sebastiano Cicco  15 , Federica Piani  16 , Marialuisa Sveva Marozzi  15 , Alberto Milan  17   18 , Dario Leone  17   18 , Chiara Cogliati  19 , Riccardo Schiavon  20 , Massimo Salvetti  21 , Michele Ciccarelli  7 , Nicola De Luca  2 , Massimo Volpe  22 , Maria Lorenza Muiesan  4   5   6   7
Affiliations
Review

Aortic Remodeling in Patients with Arterial Hypertension: Pathophysiological Mechanisms, Therapeutic Interventions and Preventive Strategies-A Position Paper from the Heart and Hypertension Working Group of the Italian Society of Hypertension

Costantino Mancusi et al. High Blood Press Cardiovasc Prev. 2025 May.

Abstract

In patient with arterial hypertension the whole aorta is exposed to increased wall stress due to pressure overload. Different blood pressure (BP) components have been reported as main determinant of aortic remodelling. In particular increased diastolic BP has been associated with aortic dilatation across all its segments with smaller increase in aortic root and ascending aorta related to increased systolic BP and pulse pressure. Optimal BP control is crucial to prevent development of aortic aneurysm and acute aortic disease. Many studies have evaluated the role of different antihypertensive drug classes for prevention of adverse aortic remodelling including beneficial effects of ACEIs, ARBs, dihydropyridinic calcium channel blockers and Beta-blockers. The present review discusses pathophysiological mechanisms, therapeutic interventions and preventive strategies for development of aortic remodeling in patients with arterial hypertension.

Keywords: Aortic aneurysm; Cardiovascular prevention; Hypertension.

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Figures

Fig. 1
Fig. 1
Effect of antihypertensive drugs on aortic remodeling
Fig. 2
Fig. 2
Studies evaluating impact different antihypertensive drugs on aortic remodeling
See this image and copyright information in PMC

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