Journal Article

Drug Treatment of Hypertension: Focus on Vascular Health

Lang, Ninian N., Cameron, Alan C., Touyz, Rhian M.

2016

Overview

Hypertension, the most common preventable risk factor for cardiovascular disease and death, is a growing health burden. Serious cardiovascular complications result from target organ damage including cerebrovascular disease, heart failure, ischaemic heart disease and renal failure. While many systems contribute to blood pressure (BP) elevation, the vascular system is particularly important because vascular dysfunction is a cause and consequence of hypertension. Hypertension is characterised by a vascular phenotype of endothelial dysfunction, arterial remodelling, vascular inflammation and increased stiffness. Antihypertensive drugs that influence vascular changes associated with high BP have greater efficacy for reducing cardiovascular risk than drugs that reduce BP, but have little or no effect on the adverse vascular phenotype. Angiotensin converting enzyme ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) improve endothelial function and prevent vascular remodelling. Calcium channel blockers also improve endothelial function, although to a lesser extent than ACEIs and ARBs. Mineralocorticoid receptor blockers improve endothelial function and reduce arterial stiffness, and have recently become more established as antihypertensive drugs. Lifestyle factors are essential in preventing the adverse vascular changes associated with high BP and reducing associated cardiovascular risk. Clinicians and scientists should incorporate these factors into treatment decisions for patients with high BP, as well as in the development of new antihypertensive drugs that promote vascular health.

• Publisher: Springer International Publishing,Springer Nature B.V
• Subject: Angiotensin II Type 1 Receptor Blockers - administration & dosage / Angiotensin II Type 1 Receptor Blockers - pharmacology / Angiotensin II Type 1 Receptor Blockers - therapeutic use / Angiotensin Receptor Antagonists - administration & dosage / Angiotensin Receptor Antagonists - chemistry / Angiotensin Receptor Antagonists - pharmacology / Angiotensin Receptor Antagonists - therapeutic use / Angiotensin-Converting Enzyme Inhibitors - administration & dosage / Angiotensin-Converting Enzyme Inhibitors - chemistry / Angiotensin-Converting Enzyme Inhibitors - pharmacology / Angiotensin-Converting Enzyme Inhibitors - therapeutic use / Antihypertensive Agents - chemistry / Antihypertensive Agents - pharmacology / Antihypertensive Agents - therapeutic use / Antihypertensives / Blood pressure / Blood Pressure - drug effects / Calcification / Calcium Channel Blockers - administration & dosage / Calcium Channel Blockers - chemistry / Calcium Channel Blockers - therapeutic use / Cardiovascular disease / Cardiovascular Diseases - prevention & control / Cerebrovascular disease / Cerebrovascular Disorders - drug therapy / Collagen / Drugs / Enzymes / Genotype & phenotype / Heart failure / Heart Failure - drug therapy / Humans / Hypertension / Hypertension - drug therapy / Inflammation / Internal Medicine / Ischemia / Kinases / Medicine / Medicine & Public Health / Mortality / Oxidative stress / Pharmacology/Toxicology / Pharmacotherapy / Renal Insufficiency - drug therapy / Review Article / Risk Factors / Signal transduction / Veins & arteries