Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, 77 Ave Louis Pasteur, NRB741, Boston, MA 02115, USA.
Pflugers Arch. 2010 May;459(6):995-1004. doi: 10.1007/s00424-010-0786-4. Epub 2010 Feb 2.
Endothelial dysfunction is a common feature of hypertension, and it results from the imbalanced release of endothelium-derived relaxing factors (EDRFs; in particular, nitric oxide) and endothelium-derived contracting factors (EDCFs; angiotensin II, endothelins, uridine adenosine tetraphosphate, and cyclooxygenase-derived EDCFs). Thus, drugs that increase EDRFs (using direct nitric oxide releasing compounds, tetrahydrobiopterin, or L-arginine supplementation) or decrease EDCF release or actions (using cyclooxygenase inhibitor or thromboxane A2/prostanoid receptor antagonists) would prevent the dysfunction. Many conventional antihypertensive drugs, including angiotensin-converting enzyme inhibitors, calcium channel blockers, and third-generation beta-blockers, possess the ability to reverse endothelial dysfunction. Their use is attractive, as they can address arterial blood pressure and vascular tone simultaneously. The severity of endothelial dysfunction correlates with the development of coronary artery disease and predicts future cardiovascular events. Thus, endothelial dysfunction needs to be considered as a strategic target in the treatment of hypertension.
内皮功能障碍是高血压的常见特征，它是由于内皮衍生的舒张因子（EDRFs；特别是一氧化氮）和内皮衍生的收缩因子（EDCFs；血管紧张素 II、内皮素、尿苷腺苷四磷酸和环氧化酶衍生的 EDCFs）的失衡释放所致。因此，增加 EDRFs 的药物（使用直接释放一氧化氮的化合物、四氢生物蝶呤或 L-精氨酸补充剂）或减少 EDCF 释放或作用的药物（使用环氧化酶抑制剂或血栓素 A2/前列腺素受体拮抗剂）可以预防功能障碍。许多传统的抗高血压药物，包括血管紧张素转换酶抑制剂、钙通道阻滞剂和第三代β受体阻滞剂，都具有逆转内皮功能障碍的能力。它们的使用很有吸引力，因为它们可以同时解决动脉血压和血管张力的问题。内皮功能障碍的严重程度与冠状动脉疾病的发展相关，并预测未来的心血管事件。因此，内皮功能障碍需要被视为高血压治疗的战略目标。
