Prevention and regression of hypertension: role of renal microvascular protection
Prevention and regression of hypertension: role of renal microvascular protection
复制标题
高血压的预防和消退：肾微血管保护的作用
作者：
H. Sasamura;Kaori Hayashi;Kimiko Ishiguro;H. Nakaya;T. Saruta;H. Itoh
高血压是一种影响世界成年人口 26.4% 以上的疾病，因此需要研究预防和治疗该疾病的新方法。我们和其他实验室之前的研究表明，在高血压发展的“关键时期”用肾素-血管紧张素系统（RAS）抑制剂治疗自发性高血压大鼠（SHR）和达尔盐敏感大鼠可预防高血压的后期发展。在人类中，朱利叶斯等人。在具有里程碑意义的 TROPHY 研究中报告了类似的发现。最近，我们报道了用大剂量血管紧张素受体阻滞剂（ARB）对 SHR 进行“脉冲”治疗可以有效地持续降低已形成的高血压，即使是在“关键期”之后开始治疗也是如此。这些结果表明，既定高血压的“回归”可能变得可行，我们已经启动了一项前瞻性、多中心临床研究（STAR CAST 研究）来检验这种可能性。在我们的动物研究中，我们发现在“关键期”用 ARB 治疗大鼠可以抑制肾小动脉肥大的发展。此外，高剂量血管紧张素阻滞剂引起 SHR 肾小动脉肥大的显着逆转，这与微血管 MMP 表达的变化有关。这些结果表明，肾微血管系统的变化可能在 ARB 预防和消退高血压的机制中发挥重要作用。
Hypertension is a disease which affects over 26.4% of the world adult population, therefore novel approaches to the prevention and treatment of this disease need to be examined. Previous studies from our and other laboratories have shown that treatment of spontaneously hypertensive rats (SHR) and Dahl salt-sensitive rats with a renin–angiotensin system (RAS) inhibitor during the ‘critical period’ in hypertension development results in prevention of the later development of hypertension. In humans, Julius et al. reported similar findings in the landmark TROPHY study. Recently, we reported that ‘pulse’ treatment of SHR with high-dose angiotensin receptor blocker (ARB) is effective in causing sustained reduction of already established hypertension, even when the treatment was started after the ‘critical period’. These results suggest the possibility that ‘regression’ of established hypertension may become feasible, and we have started a prospective, multicenter clinical study (STAR CAST study) to examine this possibility. In our animal studies, we found that treatment of rats during the ‘critical period’ with an ARB inhibits the development of renal arteriolar hypertrophy. Moreover, a high-dose angiotensin blocker caused a remarkable reversal of renal arteriolar hypertrophy in SHR, which was associated with changes in microvascular MMP expression. These results suggest that changes in the renal microvasculature may have an important role in the mechanisms of hypertension prevention and regression by ARB.
影响因子：
12.3
作者：
Zhang, L;Edwards, DG;Berecek, KH
通讯作者：
Berecek, KH