The role of prostaglandins in human hypertension.
The role of prostaglandins in human hypertension.
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DOI：
10.1016/s0272-6386(85)80063-9
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发表时间：
1985-04
期刊：
影响因子：
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通讯作者：
Michael C. Smith;M. Dunn
中科院分区：
文献类型：
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作者：
Michael C. Smith;M. Dunn
大量证据支持前列腺素(PG)在动脉血压调节中的重要作用。各种前列腺素，特别是PGE2和前列环素(PGI2)可能通过控制血管张力、钠排泄和肾素释放来影响血压。非甾体抗炎药(NSAID)抑制PG合成可增强血管收缩对血管紧张素II、精氨酸加压素(AVP)和氟化可的松等外源性加压药的反应。对血压正常或未经治疗的高血压患者急性服用非甾体抗炎药会导致动脉压和外周阻力增加；然而，长期服用非甾体抗炎药几乎不会引起血压变化，这可能是因为心输出量减少。尽管NSAID对正常血压受试者或未经治疗的高血压患者的血压影响很小，但抑制PG合成会削弱或取消大多数降压药的降压作用。非甾体抗炎药可拮抗利尿剂、β肾上腺素受体拮抗剂、血管扩张剂和转换酶抑制剂的降压作用。因此，在高血压患者的治疗过程中，如果有的话，应该谨慎使用有效的非甾体抗炎药。已有多项研究检测了原发性高血压(EH)患者肾脏PG的产生。与正常血压受试者相比，大多数EH患者的基础和刺激尿PGE2排泄量减少，但有很大的重叠。然而，在大约三分之一的EH患者中，肾脏PGE2合成显著减少。最近一种动脉血压调节的创新方法集中在饮食中补充多不饱和脂肪酸(PUFA)，特别是亚油酸和二十碳五烯酸。几个小组已经证明，长期补充多不饱和脂肪酸可以降低血压正常的个体和EH患者的血压。补充多不饱和脂肪酸的有益作用可能与促进血管扩张剂或利钠药前列腺素的合成有关。
A large body of evidence supports the concept that prostaglandins (PG) are importantly involved in arterial pressure regulation. Various PGs, especially PGE2and prostacyclin (PGI2) may influence blood pressure through control of vascular tone, sodium excretion, and renin release. Inhibition of PG synthesis by nonsteroidal antiinflammatory drugs (NSAID) augments the vasoconstrictor response to exogenous pressors such as angiotensin II, arginine vasopressin (AVP), and fludrocortisone. The acute administration of NSAID to either normotensive or untreated hypertensive subjects results in an increase in arterial pressure and peripheral resistance; long-term administration, however, is associated with little or no change in blood pressure, possibly because of a reduction in cardiac output. Although NSAID have little influence on blood pressure in normotensive subjects or untreated hypertensives, inhibition of PG synthesis blunts or abolishes the anti hypertensive effect of most anti hypertensive agents. NSAID antagonize the vasodepressor action of diuretics, β-adrenoreceptor antagonists, vasodilators, and converting enzyme inhibitors. Consequently, potent NSAID should be used with caution, if at all, during treatment of hypertensive patients. Numerous studies have examined renal PG production in essential hypertension (EH). The majority have demonstrated reduced basal and stimulated urinary PGE2excretion in EH compared to normotensive subjects, but there is substantial overlap. Nevertheless, renal PGE2synthesis is significantly decreased in approximately one-third of patients with EH. A recent innovative approach to arterial pressure regulation has focused on dietary supplementation with polyunsaturated fatty acids (PUFA), especially linoleic acid and eicosapentaenoic acid. Several groups have demonstrated that long-term dietary supplementation with PUFA reduces blood pressure in both normotensive individuals and in patients with EH. The beneficial effect of PUFA supplementation may be related to enhanced synthesis of vasodilator or natriuretic PGs.