Department of Regenerative Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan.
Hypertens Res. 2022 Aug;45(8):1322-1333. doi: 10.1038/s41440-022-00936-x. Epub 2022 May 20.
Blood-pressure-lowering therapy with antihypertensive drugs can reduce the risk of cardiovascular morbidity and mortality in patients with hypertension. However, patients treated with antihypertensive drugs generally have a worse prognosis than untreated individuals. Consistent with the results obtained from epidemiological studies, a clinical study showed that endothelial function was impaired more in treated patients with hypertension than in untreated individuals with the same blood pressure level, suggesting that blood-pressure-lowering therapy with currently available antihypertensive drugs cannot restore endothelial function to the level of that in untreated individuals. Several mechanisms of endothelial dysfunction in treated patients are postulated: irreversible damage to the endothelium caused by higher cumulative elevated blood pressure exposure over time; the persistence of the primary causes of hypertension even after the initiation of antihypertensive drug treatment, including an activated renin-angiotensin-aldosterone system, oxidative stress, and inflammation; and higher global cardiovascular risk related not only to conventional cardiovascular risk factors but also to undetectable nonconventional risk factors. Lifestyle modifications/nonpharmacological interventions should be strongly recommended for both untreated and treated individuals with hypertension. Lifestyle modifications/nonpharmacological interventions may directly correct the primary causes of hypertension, which can improve endothelial function and consequently reduce cardiovascular risk regardless of the use or nonuse of antihypertensive drugs.
降压治疗（使用降压药物）可以降低高血压患者发生心血管疾病发病率和死亡率的风险。然而，接受降压药物治疗的患者预后通常比未接受治疗的患者差。与流行病学研究的结果一致，一项临床研究表明，与血压水平相同的未接受治疗的个体相比，接受降压药物治疗的高血压患者的内皮功能受损更严重，这表明目前可用的降压药物治疗并不能将内皮功能恢复到未接受治疗的个体的水平。推测接受降压药物治疗的患者内皮功能障碍的几个机制包括：随着时间的推移，累积升高的血压暴露导致内皮细胞不可逆转的损伤；即使在开始降压药物治疗后，高血压的主要病因仍然存在，包括激活的肾素-血管紧张素-醛固酮系统、氧化应激和炎症；以及与传统心血管危险因素相关的更高的全球心血管风险，还包括不可检测的非传统危险因素。对于未接受治疗和接受治疗的高血压患者，均应强烈推荐进行生活方式改变/非药物干预。生活方式改变/非药物干预可能直接纠正高血压的主要病因，从而改善内皮功能，进而降低心血管风险，无论是否使用降压药物。
