Mulvany M J
Department of Pharmacology, Aarhus University, Denmark.
J Cardiovasc Pharmacol. 1991;17 Suppl 2:S58-63.
The purpose of this article is to review the evidence that the resistance vasculature is altered in hypertension, the role that it may play in the pathogenesis of the disease, and the effect of antihypertensive treatment on the abnormalities. In some models of hypertension, functional changes (i.e., increased vascular smooth muscle sensitivity) have been found, but in human essential hypertension, it appears that structural changes in the resistance vasculature predominate. The structural changes result in an increased media:lumen ratio of the resistance vessels, but it is not clear if these changes are also associated with an increased synthesis of vascular wall material, or whether they can alone be due to a remodeling of the vascular wall (i.e., redistribution of existing material). In both essential hypertension and in the spontaneously hypertensive rat, vascular smooth muscle volume appears to be normal, but is increased in renal hypertensive rats, suggesting that hypertrophy may be a response to imposed increases in load. Although there seems to be a close correlation between altered media:lumen ration and blood pressure in all forms of hypertension investigated, it is generally found to be difficult to obtain full regression of vascular structure. The reason for this remains obscure.
本文的目的是综述有关高血压时阻力血管系统发生改变的证据、其在疾病发病机制中可能发挥的作用以及抗高血压治疗对这些异常情况的影响。在一些高血压模型中，已发现功能改变（即血管平滑肌敏感性增加），但在人类原发性高血压中，似乎阻力血管系统的结构改变更为突出。这些结构改变导致阻力血管的中膜与管腔比值增加，但尚不清楚这些改变是否也与血管壁物质合成增加有关，或者它们是否仅由血管壁重塑（即现有物质的重新分布）引起。在原发性高血压和自发性高血压大鼠中，血管平滑肌体积似乎正常，但在肾性高血压大鼠中增加，这表明肥大可能是对负荷增加的一种反应。尽管在所有研究的高血压形式中，中膜与管腔比值改变与血压之间似乎存在密切相关性，但通常发现很难使血管结构完全恢复正常。其原因仍不清楚。
