Pharmacology of cardiac and vascular remodeling.

Cardiovascular diseases involve changes in the structure of the heart and blood vessels. Normal structure is maintained by a sophisticated set of mechanical and cellular "checks and balances." A disturbance of these checks and balances induces a remodeling process. The most distinguished features of this process are phenotypic modulation of various cell types in the cardiovascular system; cellular hyperplasia and hypertrophy; and extracellular matrix production, deposition, and degradation. Optimal pharmacotherapy of cardiovascular diseases should be aimed at correcting structural abnormalities in the heart and blood vessels. This goal can be achieved by influencing mechanical stresses on the cardiovascular system or by interfering with the chemical mediators of the remodeling process. Many existing groups of cardiovascular drugs, such as angiotensin-converting enzyme inhibitors, calcium-antagonists, alpha- and beta-adrenoceptor antagonists, and antithrombotic drugs, influence cardiovascular remodeling. New approaches involve the development of drugs acting on peptidergic mediators of cardiovascular remodeling.