Landmesser Ulf, Drexler Helmut
Abteilung Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Germany.
Curr Opin Cardiol. 2007 Jul;22(4):316-20. doi: 10.1097/HCO.0b013e3281ca710d.
Endothelial dysfunction, in particular a reduced vascular availability of endothelium-derived nitric oxide, has been analysed in numerous experimental and clinical studies as a potential mechanism mediating the adverse vascular effects of hypertension. This paper outlines some notable studies in this dynamic field published recently.
The understanding of mechanisms underlying endothelial dysfunction in hypertension has been substantially advanced recently. Increased oxidant stress is thought to represent a major mechanism leading to reduced vascular availability of endothelium-derived nitric oxide. Vascular nicotinamide adenine dinucleotide phosphate oxidases, uncoupled nitric oxide synthase and xanthine oxidase have been identified as major sources of reactive oxygen species in hypertension. Endothelial dysfunction has been implicated in the macrovascular complications of hypertension, such as stroke or myocardial infarction, coronary microvascular dysfunction and increased arterial stiffness, probably at least partly resulting from loss of the antiatherogenic and vasculoprotective effects of endothelium-derived nitric oxide.
Recent research on endothelial dysfunction supports its clinical significance in hypertension, and has led to important insights into the pathophysiology of the disease. These observations suggest that targeting endothelial dysfunction, in particular reduced nitric oxide availability, would exert beneficial effects in hypertensive patients. This concept needs further evaluation in clinical studies.
内皮功能障碍,尤其是内皮源性一氧化氮的血管可用性降低,已在众多实验和临床研究中作为介导高血压不良血管效应的潜在机制进行了分析。本文概述了该动态领域最近发表的一些重要研究。
最近对高血压内皮功能障碍潜在机制的理解有了实质性进展。氧化应激增加被认为是导致内皮源性一氧化氮血管可用性降低的主要机制。血管烟酰胺腺嘌呤二核苷酸磷酸氧化酶、解偶联型一氧化氮合酶和黄嘌呤氧化酶已被确定为高血压中活性氧的主要来源。内皮功能障碍与高血压的大血管并发症有关,如中风或心肌梗死、冠状动脉微血管功能障碍和动脉僵硬度增加,这可能至少部分是由于内皮源性一氧化氮的抗动脉粥样硬化和血管保护作用丧失所致。
最近关于内皮功能障碍的研究支持了其在高血压中的临床意义,并对该疾病的病理生理学有了重要见解。这些观察结果表明,针对内皮功能障碍,特别是一氧化氮可用性降低,将对高血压患者产生有益影响。这一概念需要在临床研究中进一步评估。