Endothelial and vascular smooth muscle dysfunction in hypertension

Area of Science:

• Cardiovascular Medicine
• Pharmacology

Background:

• Essential hypertension pathogenesis involves vascular dysfunction, including endothelial dysfunction, inflammation, and structural remodeling.
• Key molecular pathways implicated in vascular dysfunction include the renin-angiotensin-aldosterone system (RAAS), endothelin, nitric oxide signaling, and oxidative stress.

Purpose of the Study:

• To review the molecular pathways contributing to vascular dysfunction in essential hypertension.
• To discuss the role of various pharmacological classes in managing hypertension by targeting cardiac output and vascular function.

Main Methods:

• Literature review focusing on molecular mechanisms of vascular dysfunction.
• Analysis of pharmacological agents targeting key pathways in hypertension management.

Main Results:

• Identified RAAS, endothelin, nitric oxide, and oxidative stress as critical molecular pathways in vascular dysfunction.
• Examined approved and investigational drug classes, including RAAS inhibitors, dual angiotensin receptor-neprilysin inhibitors, endothelin receptor antagonists, soluble guanylate cyclase modulators, PDE5 inhibitors, and SGLT2 inhibitors.

Conclusions:

• Vascular dysfunction is central to essential hypertension development and maintenance.
• Several pharmacological classes offer potential therapeutic benefits for hypertension by modulating identified molecular pathways.