Hypertension and Endothelial Dysfunction: Therapeutic Approach
A large body of evidence indicates that patients with essential hypertension are characterized by endothelial dysfunction mediated by an impaired NO availability secondary to oxidative stress production. A dysfunctioning endothelium is an early marker of the development of atherosclerotic changes and can also contribute to cardiovascular events. Vascular reactivity tests represent the most widely used methods in the clinical assessment of endothelial function. In the last two decades, many studies have evaluated the endothelium in hypertensive patients, using different techniques. Several methodologies were developed to study microcirculation (resistance arteries and arterioles) and macrocirculation (conduit arteries), both in coronary and peripheral vascular districts. This review will describe the most relevant available techniques in the research on endothelial dysfunction in essential hypertension, their advantages and limitations, focusing on available data on endothelial dysfunction and on the effect of treatment. Endothelial dysfunction in the coronary and peripheral circulation of hypertensive patients are associated with hypertensive target organ damage and it is predictive of cardiovascular events. Several non-pharmacological approaches, including physical exercise and dietary interventions, can ameliorate endothelial function in hypertensive patients. Despite blood pressure reduction per se is not effective, some antihypertensive drugs can improve endothelial dysfunction, particularly calcium channel antagonist in the microcirculation, ACE-inhibitors and AT1-receptor antagonists mostly in conduit arteries. Some beneficial effects were also exerted by nebivolol and statins. Future studies are needed to confirm whether the improvement in endothelial dysfunction is associated to better cardiovascular prognosis in hypertension.
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Document Type: Research Article
Publication date: 2012-01-01
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- Vascular disease is the commonest cause of death in Westernized countries and its incidence is on the increase in developing countries. It follows that considerable research is directed at establishing effective treatment for acute vascular events. Long-term treatment has also received considerable attention (e.g. for symptomatic relief). Furthermore, effective prevention, whether primary or secondary, is backed by the findings of several landmark trials.
Vascular disease is a complex field with primary care physicians and nurse practitioners as well as several specialties involved. The latter include cardiology, vascular and cardio thoracic surgery, general medicine, radiology, clinical pharmacology and neurology (stroke units). Current Vascular Pharmacology will publish reviews to update all those concerned with the treatment of vascular disease. For example, reviews commenting on recently published trials or new drugs will be included. In addition to clinically relevant topics we will consider 'research-based' reviews dealing with future developments and potential drug targets. Therefore, another function of Current Vascular Pharmacology is to bridge the gap between clinical practice and ongoing research.
Debates will also be encouraged in the correspondence section of this journal.