Rodrigo Ramón, Passalacqua Walter, Araya Julia, Orellana Myriam, Rivera Gonzalo
Instituto de Ciencias Biomédicas, Programa de Farmacología Molecular y Clínica, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
J Clin Pharmacol. 2003 Dec;43(12):1299-306. doi: 10.1177/0091270003258190.
The authors examine the available clinical and experimental data supporting the view that homocysteine, an alternative risk factor of cardiovascular disease, may play a role in the pathogenesis of essential hypertension. The mechanism of this disease has not been elucidated, but it may be related to impairment of vascular endothelial and smooth muscle cell function. Therefore, the occurrence of endothelial dysfunction could contribute to alterations of the endothelium-dependent vasomotor regulation. Elevated homocysteinemia diminishes the vasodilation by nitric oxide, increases oxidative stress, stimulates the proliferation of vascular smooth muscle cells, and alters the elastic properties of the vascular wall. Thus, homocysteine contributes to elevate the blood pressure. Also it is known that elevated plasma levels of homocysteine could lead to oxidant injury to the endothelium. The correction of elevated homocysteinemia by administration of vitamins B12 and B6 plus folic acid, could be a useful adjuvant therapy of hypertension. However, further controlled randomized trials are necessary to establish the efficacy and tolerability of these potentially therapeutic agents.
作者们研究了现有临床和实验数据，这些数据支持同型半胱氨酸（心血管疾病的另一个风险因素）可能在原发性高血压发病机制中起作用这一观点。该疾病的发病机制尚未阐明，但可能与血管内皮和平滑肌细胞功能受损有关。因此，内皮功能障碍的发生可能导致内皮依赖性血管舒缩调节的改变。高同型半胱氨酸血症会减少一氧化氮介导的血管舒张，增加氧化应激，刺激血管平滑肌细胞增殖，并改变血管壁的弹性特性。因此，同型半胱氨酸会促使血压升高。此外，已知血浆同型半胱氨酸水平升高会导致内皮的氧化损伤。通过给予维生素B12、B6和叶酸来纠正高同型半胱氨酸血症，可能是高血压的一种有用辅助治疗方法。然而，需要进一步的对照随机试验来确定这些潜在治疗药物的疗效和耐受性。
