Research Centers in Minority Institutions Clinical Rese*

描述（申请人提供）：非裔美国人高血压的自然史特征为病程更严重，靶器官损伤（如左心室肥大（LVH）、心力衰竭和肾衰竭）的患病率更高。据推测，这一高风险组反映了高血压表型，其中LVH的易感性与内皮功能异常相关，内皮功能异常易使冠状动脉循环内的血管收缩和结构性微血管闭塞。启动一系列病理生物学过程，易导致心肌缺血、复发性微梗死、心力衰竭和最终的心脏死亡。具体目标是：一。明确ACE/ANGN/EC-NOS基因型作为非裔美国人高血压患者肱动脉内皮功能障碍决定因素的相对作用。二.明确无症状非裔美国人高血压患者ACE/ANGN/EC-NOS基因型、肱动脉内皮功能障碍和诱导性心肌缺血之间的相互关系。三.评估有症状的非裔美国高血压患者肱动脉内皮功能、冠状动脉内皮功能和诱导性心肌缺血之间的相互关系。四.确定血管紧张素转换酶抑制剂长期治疗作为改善具有基线内皮功能障碍和可诱导心肌缺血的非裔美国人高血压患者内皮功能的一种手段的疗效。

Description (Provided by Applicant): The natural history of hypertension among African-Americans is characterized by a more virulent course, a higher prevalence of target organ damage such as left ventricular hypertrophy (LVH), heart failure and renal failure. It is postulated that this high risk group reflects a hypertensive phenotype in which a predisposition to LVH is associated with abnormalities in endothelial function that predispose to vasoconstriction and structural microvessel occlusion within the coronary circulation. Setting in motion a cascade of pathobiological processes that predispose to myocardial ischemia, recurrent micro-infarctions, heart failure and eventual cardiac mortality. The Specific Aims are: I. Define the relative contribution of ACE/ANGN/EC-NOS genotypes as determinants of brachial artery endothelial dysfunction in African-American hypertensives. II. Define the interrelationship between the ACE/ANGN/EC-NOS genotypes, brachial artery endothelial dysfunction and inducible myocardial ischemia in asymptomatic African-American hypertensives. III. Assess the interrelationship between brachial artery endothelial function, coronary artery endothelial function and inducible myocardial ischemia in symptomatic African-American patients with hypertension. IV. Define the efficacy of chronic treatment with angiotensin converting enzyme inhibitors as a means to improve endothelial function in African-American hypertensives with baseline endothelial dysfunction and inducible myocardial ischemia.