The article proposed this month is entitled: “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”. As it is well-known aorta is exposed to a very high shear and pressure stresses throughout the life. The main objective of the this interesting review is to highlight the pathophysiological mechanisms related to the development of aortic remodeling in patients with arterial hypertension. Remodeling of aorta is influenced differently by the different blood pressure (BP) components. Diastolic BP (DBP) plays a pivotal role in the development of aortic dilatation across all its segments and  Systolic BP (SBP) and pulse pressure (PP) are associated with a smaller increase in aortic root and ascending aorta dimensions and exert a smaller influence on abdominal aorta compared to DBP. The graphical abstract with which the article begins perfectly summarizes the hemodynamic and non-hemodynamic mechanisms that influence aortic remodeling. In the same way, the mechanisms of the different antihypertensive drugs and their effects on aortic remodeling are summarized and represented. Main studies on the influence of antihypertensive drugs and aortic stiffness are summarized in a table, as well as studies evaluating the impact of different antihypertensive drugs on aortic remodeling. Risk stratification for aortic dissection is also reviewed, as is the therapeutic target for blood pressure in patients with acute and chronic aortic dissection. Finally, preventative strategies for acute aortic syndromes in patients with arterial hypertension are reviewed, as well as research perspectives.

As a conclusion: Preventive strategies for acute aortic syndrome include tight control of BP and all cardio vascular risk factors, especially in patients with aortic aneurysm. Among antihypertensive drugs betablockers, ACEIs, ARBs and CCBs have been demonstrated to influence aortic remodeling. Healthy lifestyles should be promoted, avoiding alcohol and tobacco, and exercising. Pharmacological strategies aim to stabilize and prevent aneurysm progression using statins, beta-blockers, and ARBs.