Vascular protection: current possibilities and future perspectives

Area of Science:

• Cardiovascular Physiology
• Endothelial Biology
• Pharmacology

Background:

• Endothelial cells mediate vascular smooth muscle and blood cell functions via vasoactive substances.
• Key vasodilators include prostacyclin, bradykinin, and nitric oxide (NO), while angiotensin II and endothelin-1 are vasoconstrictors.
• Endothelial dysfunction, caused by cardiovascular risk factors, underlies cardiovascular disease.

Purpose of the Study:

• To explore the role of endothelial cells in cardiovascular regulation.
• To review therapeutic strategies aimed at preserving or restoring endothelial integrity.
• To examine the mechanisms of action for calcium antagonists, ACE inhibitors, and novel endothelin-1 antagonists.

Main Methods:

• Review of existing literature on endothelial function and cardiovascular pharmacology.
• Analysis of the effects of various drug classes on endothelial function and vascular tone.
• Discussion of experimental and clinical findings related to endothelial dysfunction treatments.

Main Results:

• Nitric oxide and prostacyclin exhibit antiatherogenic and thromboresistant properties.
• Angiotensin II and endothelin-1 promote prothrombotic and inflammatory responses.
• ACE inhibitors enhance bradykinin activity, increasing nitric oxide release and improving endothelial function.
• Neutral endopeptidase inhibitors, especially with ACE inhibitors, show antihypertensive effects by affecting natriuretic peptides and endothelin-1.

Conclusions:

• Restoring endothelial function is a key therapeutic goal in cardiovascular disease.
• ACE inhibitors provide cardiovascular benefits exceeding blood pressure reduction, likely via improved endothelial function.
• Endothelin-1 antagonists show promise for hypertension and heart failure, warranting further clinical investigation.