Lahera V, Navarro-Cid J, Maeso R, Cachofeiro V
Departamento de Fisiología, Facultad de Medicina, Universidad Complutense, Madrid.
Rev Esp Cardiol. 1999;52 Suppl 3:4-11.
Vascular endothelial cells synthesize and release vasodilator (nitric oxide, prostacyclin, endothelium-derived hyperpolarizing factor) and vasoconstrictor factors (thromboxane A2, prostaglandin H2, endothelin 1), which play a key role in the local regulation of vascular tone and participate in a crucial manner in the regulation of blood pressure. Hypertension has been shown to be associated with functional changes in the endothelium. In fact, decreased endothelium-dependent relaxations and increased endothelium-dependent contractions have been reported in both conduit arteries and resistance arteries obtained from various animal models of hypertension. During hypertension, the vessel wall experiences changes in the balance of the oxidative and the antioxidative enzyme system, resulting in increases in O2- release. This contributes to endothelial dysfunction by nitric oxide oxidation and the subsequent formation of peroxynitrite (ONOO-), a potent oxidant and potential mediator of vascular tissue injury. Finally, hypertension also allows the action or the production of vasoconstrictor factors such as endothelin 1 and thromboxane A2. As a consequence of these mechanisms, basal and/or stimulated nitric oxide availability is reduced, allowing vasoconstrictor systems, such as angiotensin II, sympathetic nervous system and others to over-express their actions. The mechanisms responsible for the alterations leading to endothelial dysfunction not only affect vasomotor tone, but also platelet aggregation and coagulation mechanisms.
血管内皮细胞合成并释放血管舒张因子(一氧化氮、前列环素、内皮衍生超极化因子)和血管收缩因子(血栓素A2、前列腺素H2、内皮素1),这些因子在局部血管张力调节中起关键作用,并以关键方式参与血压调节。高血压已被证明与内皮功能变化有关。事实上,在从各种高血压动物模型获得的传导动脉和阻力动脉中,均已报道内皮依赖性舒张功能降低和内皮依赖性收缩功能增强。在高血压期间,血管壁的氧化酶系统和抗氧化酶系统平衡发生变化,导致超氧阴离子(O2-)释放增加。这通过一氧化氮氧化以及随后过氧亚硝酸根(ONOO-)的形成导致内皮功能障碍,过氧亚硝酸根是一种强效氧化剂和血管组织损伤的潜在介质。最后,高血压还会使内皮素1和血栓素A2等血管收缩因子的作用或产生增强。由于这些机制,基础和/或刺激状态下的一氧化氮可用性降低,使得血管收缩系统,如血管紧张素II、交感神经系统等过度发挥其作用。导致内皮功能障碍的改变所涉及的机制不仅影响血管舒缩张力,还影响血小板聚集和凝血机制。