Vogel Robert A
University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Prev Cardiol. 2006 Winter;9(1):35-41. doi: 10.1111/j.1520-037x.2006.4473.x.
Endothelial dysfunction is an important factor in the pathogenesis of atherosclerosis, hypertension, and heart failure. The endothelium mediates vascular tone, structure, and function by the release and regulation of multiple vasoactive substances that promote or inhibit vasodilation, vasoconstriction, cell growth, and other mechanisms. The effect of antihypertensive drugs on endothelial function may be an important indicator of their ability to reduce risks for cardiovascular morbidity and mortality. Endothelium-dependent vasodilation induced by various antihypertensive drugs is accurately measured with high-resolution ultrasound of flow-mediated dilation of the brachial artery. Calcium channel blockers and angiotensin-converting enzyme inhibitors have been shown to reverse endothelial dysfunction. The benefits of angiotensin-converting enzyme inhibitors and calcium channel blockers on the endothelium are believed to derive from their effects on nitric oxide production and antioxidant effects, possibly independent of blood pressure reduction. Due to their complementary mechanisms of action, it has been hypothesized that the combination of an angiotensin-converting enzyme inhibitor and a calcium channel blocker will provide superior cardiovascular protection, in part by producing an additive effect of increased nitric oxide availability, when compared with either agent alone.
内皮功能障碍是动脉粥样硬化、高血压和心力衰竭发病机制中的一个重要因素。内皮通过释放和调节多种血管活性物质来介导血管张力、结构和功能，这些物质可促进或抑制血管舒张、血管收缩、细胞生长及其他机制。降压药物对内皮功能的影响可能是其降低心血管发病和死亡风险能力的一个重要指标。通过高分辨率超声测量肱动脉血流介导的舒张功能，可以准确测定各种降压药物诱导的内皮依赖性血管舒张。钙通道阻滞剂和血管紧张素转换酶抑制剂已被证明可逆转内皮功能障碍。血管紧张素转换酶抑制剂和钙通道阻滞剂对内皮的益处被认为源于它们对一氧化氮生成的影响和抗氧化作用，可能独立于血压降低作用。由于它们的作用机制具有互补性，因此有人推测，与单独使用任何一种药物相比，血管紧张素转换酶抑制剂和钙通道阻滞剂联合使用将提供更好的心血管保护，部分原因是通过增加一氧化氮的可用性产生相加效应。
