Ruschitzka F, Noll G, Lüscher T F
Department of Cardiology, University Hospital Zürich, Switzerland.
J Cardiovasc Pharmacol. 1999 Aug;34 Suppl 1:S3-12. doi: 10.1097/00005344-199908001-00002.
Strategically located between the circulating blood and the vascular smooth muscle, endothelial cells release numerous vasoactive substances regulating the function of vascular smooth muscle and circulating blood cells. Endothelium-derived vasodilators include prostacyclin, nitric oxide and endothelium-derived hyperpolarizing factor. In particular, nitric oxide inhibits cellular growth and migration. In concert with prostacyclin, nitric oxide exerts potent antiatherogenic and thromboresistant properties by preventing platelet aggregation and cell adhesion. These effects are counterbalanced by vasoconstrictors, such as angiotensin II and endothelin (ET)-1, both of which exert prothrombotic and growth-promoting properties. In hypertension, elevated blood pressure causes vascular disease by inducing endothelial dysfunction. Hence, modern therapeutic strategies in human hypertension focus on preserving or restoring endothelial integrity. Beyond inhibiting the renin-angiotensin system, angiotensin-converting enzyme (ACE) inhibitors diminish the inactivation of bradykinin, thus leading to an augmentation of nitric oxide release. In addition, the compounds stabilize the B2-receptor, and reduce oxidative stress and tissue ET-1 levels. In patients with coronary artery disease, chronic ACE inhibition improves endothelial function. Further clinical studies are already under way which will prove whether these beneficial vascular effects of ACE inhibitors on endothelial dysfunction result in a clinical benefit for patients with hypertension.
内皮细胞位于循环血液和血管平滑肌之间的关键位置，可释放多种血管活性物质，调节血管平滑肌和循环血细胞的功能。内皮源性血管舒张剂包括前列环素、一氧化氮和内皮源性超极化因子。特别是，一氧化氮可抑制细胞生长和迁移。与前列环素协同作用，一氧化氮通过防止血小板聚集和细胞黏附发挥强大的抗动脉粥样硬化和抗血栓形成特性。这些作用被血管收缩剂如血管紧张素 II 和内皮素（ET）-1 所抵消，二者均具有促血栓形成和促进生长的特性。在高血压中，血压升高通过诱导内皮功能障碍导致血管疾病。因此，现代人类高血压治疗策略侧重于维持或恢复内皮完整性。除了抑制肾素-血管紧张素系统外，血管紧张素转换酶（ACE）抑制剂还可减少缓激肽的失活，从而导致一氧化氮释放增加。此外，这些化合物可稳定 B2 受体，并降低氧化应激和组织 ET-1 水平。在冠心病患者中，长期使用 ACE 抑制剂可改善内皮功能。进一步的临床研究正在进行中，以证明 ACE 抑制剂对内皮功能障碍的这些有益血管作用是否会给高血压患者带来临床益处。
