Effects of antihypertensive therapy on hypertensive vascular disease.
Hypertension is associated with alterations in the structure, function, and mechanical properties of large and small arteries. Changes in the endothelium, smooth muscle cell, extracellular matrix, and possibly the adventitia, contribute to complications of hypertension. In large arteries, vascular hypertrophy is found, often with increased stiffness of media components. In small arteries, particularly in mild hypertension, rearrangement of smooth muscle cells around a smaller lumen without changes in media volume (eutrophic remodeling) occurs; in more severe hypertension, hypertrophic remodeling with increased vascular stiffness can be found. Vascular remodeling is accompanied by an increase in the extracellular matrix, particularly collagen deposition. Recent studies have demonstrated that vascular remodeling and endothelial dysfunction of small and large vessels may be normalized by treatment with some antihypertensive agents (angiotensin converting enzyme inhibitors, angiotensin AT(1) receptor antagonists, and long-acting calcium channel blockers). Angiotensin converting enzyme inhibitors have now been shown to improve outcomes in hypertensive patients, an effect that may in part be related to the vascular protective effects reviewed here.
Park
J B
JB
MRC Multidisciplinary Research Group on Hypertension, Clinical Research Institute of Montréal, 110 Pine Avenue West, Montréal, Québec, Canada H2W 1R7.
Schiffrin
E L
EL
D000803:Angiotensin I / Q000037:antagonists & inhibitors; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001158:Arteries / Q000187:drug effects; D001160:Arterioles / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003094:Collagen / Q000187:drug effects; D004547:Elastic Tissue / Q000187:drug effects; D004548:Elasticity; D004730:Endothelium, Vascular / Q000187:drug effects; D005109:Extracellular Matrix / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D006984:Hypertrophy; D009131:Muscle, Smooth, Vascular / Q000187:drug effects; D020011:Protective Agents / Q000627:therapeutic use; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000188:drug therapy*
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D020011:Protective Agents; D003094:Collagen; D000803:Angiotensin I