Abstract

The vessel wall was once considered to be a passive conduit responding to the circulating endocrine system. However, the emergence of molecular and vascular biology in hypertension research has redefined our understanding of the role of the vasculature as a vital organ in the pathogenesis of hypertension. It is now recognized that the vasculature can regulate its own tone by a variety of previously unknown autocrine and/or paracrine vasoactive systems. Recent evidence indicates that the process of vascular remodeling in hypertension appears to be mediated by locally generated factors within the vessel wall. This review examines the implications of this new paradigm in hypertension, focusing on five topics that have developed through the emergence of molecular vascular biology: the discovery and characterization of novel biologically active molecules synthesized by the vessel wall, the molecular mechanisms and consequences of vascular remodeling, the developmental biology of the blood vessel and the relation to pathobiology, the use of in vivo gene transfer to test hypotheses in vivo, and novel treatment strategies based on gene therapy of the vessel wall.