What vascular changes does chronic hypertension induce and how do these affect risk?

• A. Decreased arterial stiffness
• B. Decreased pulse pressure
• C. Reduced capillary density
• D. Arteriosclerosis, vascular remodeling, arteriolar narrowing, and increased pulse pressure

Answer: (D)

Chronic hypertension causes arteries to stiffen and walls to thicken, a process called arteriosclerosis. The vessels also remodel structurally, with more smooth muscle and connective tissue, which narrows small arteries and arterioles. This reduced compliance and narrowed lumens raise vascular resistance and contribute to an increased pulse pressure—the difference between systolic and diastolic pressures grows because the stiff arteries can’t recoil normally. Together, these changes place more pulsatile stress on target organs, increasing the risk of stroke, heart failure, kidney damage, and retinopathy. So the pattern of arteriosclerosis, vascular remodeling, arteriolar narrowing, and increased pulse pressure best captures how chronic hypertension alters vessels and elevates risk.