Endothelial dysfunction: its role in hypertensive coronary disease

Abstract

Purpose of review-Coronary artery disease is the major cause of death worldwide. Hypertension is a major risk factor for developing coronary disease. It is now recognized that endothelial dysfunction is an early marker of coronary artery disease before structural changes to the vessel wall are apparent on angiography or intravascular ultrasound and that it has a prognostic value in predicting cardiovascular events in hypertensive patients. This review addresses recent developments in hypertension-induced endothelial dysfunction.Recent findings-Hyperaldosteronism causes endothelial dysfunction independent of high blood pressure. Exaggerated exercise blood pressure response has been related to endothelial dysfunction. Cyclosporin-A-induced endothelial dysfunction is related to reduced cholesterol content in caveolae. Chronic kidney disease induces changes in caveoli-1 and thus contributes to the reduced nitric oxide bioavailability, and causes oxidative stress independent of the high blood pressure. Asymmetric dimethylarginine plays a role in endothelial dysfunction in hypertensive patients independent of insulin resistance. 20-Hydroxyeicosatetraenoic acid is an independent predictor of hypertension in postmenopausal women. Endothelial dysfunction precedes and predicts the development of hypertension in postmenopausal women. Oral treatment with Larginine improves endothelial dysfunction in hypertensives and lowers the blood pressure.Summary-The pathophysiology of endothelial dysfunction in hypertension is multifactorial. Recent findings have contributed to our understanding of mechanisms of endothelial dysfunction and support a role for early intervention to prevent irreversible vascular and organ damage.

Chronic ouabain treatment increases the contribution of nitric oxide to endothelium-dependent relaxation

“…This dysfunction presents different characteristics depending of the hypertension model studied (3,5,27). However, the relaxation induced by acetylcholine in rat aorta remains unmodified after ouabain treatment.…”

Transgenic expression of a dominant negative KATPchannel subunit in the mouse endothelium: effects on coronary flow and endothelin‐1 secretion

“…This has important implications for the use of sulfonylureas in treating type II diabetes as well as familial mutations of K ATP channel subunits. Since endothelial function predicts future development of coronary artery disease (54), our results may also have profound implications for understanding and treating patients with myocardial ischemia and infarction, and possibly even hypertension-induced endothelial dysfunction (55).…”

Impact of dairy consumption on essential hypertension: a clinical study

“…Endothelial dysfunction is an early marker of vascular damage and increases the risk of coronary artery disease [4, 5]. These cardiovascular risk factors are closely related, and treating hypertension improves endothelial function [5]. As an important public health burden, promoting a healthy lifestyle and diet is essential.…”