Mulvany Michael J
Department of Pharmacology, University of Aarhus, University Park 240, 8000 Aarhus C, Denmark.
Med Biol Eng Comput. 2008 May;46(5):461-7. doi: 10.1007/s11517-008-0305-3.
Essential hypertension is treated primarily with a view to reducing blood pressure, and not with regard to normalizing the main pathological changes: the peripheral resistance and the cardiovascular structure. The aim of this review is to discuss whether normalization of the latter parameters, in particular resistance vessel structure, may also be a target for therapy. The review presents first the evidence for altered structure of the resistance vasculature, an increase in the media:lumen ratio of the vessels due to inward eutrophic remodelling. Secondly the degree to which it may be possible to rectify the abnormal structure is discussed, where it is shown that there is strong evidence that this requires a therapy which causes vasodilatation in the patient concerned. Thirdly evidence is presented that altered small artery structure appears to have prognostic consequences. Fourthly, the cellular mechanisms which may be involved are discussed, where there is evidence that vasoconstriction in itself can cause inward remodelling, and that this can be prevented by vasodilators. Finally, the consequences of these findings are considered as regards clues for strategies that may be able to improve the outcome of antihypertensive therapy. The review concludes that there is reasonably strong evidence that a treatment which reduces peripheral resistance in the individual patient will, apart from reducing blood pressure, also improve the abnormal structure.
原发性高血压的治疗主要旨在降低血压，而非使主要病理改变（外周阻力和心血管结构）正常化。本综述的目的是讨论使后述参数（特别是阻力血管结构）正常化是否也可成为治疗目标。该综述首先阐述了阻力血管系统结构改变的证据，即由于内向性营养性重塑导致血管中膜与管腔比值增加。其次讨论了纠正异常结构的可能性程度，结果表明有充分证据表明这需要一种能使相关患者血管舒张的治疗方法。第三，给出了小动脉结构改变似乎具有预后影响的证据。第四，讨论了可能涉及的细胞机制，有证据表明血管收缩本身可导致内向性重塑，而血管舒张剂可预防这种情况。最后，考虑了这些发现对于可能改善抗高血压治疗效果的策略线索的影响。该综述得出结论，有相当充分的证据表明，在个体患者中降低外周阻力的治疗方法，除了降低血压外，还将改善异常结构。
