Interventional procedures and future drug therapy for hypertension.

Hypertension management poses a major challenge to clinicians globally once non-drug (lifestyle) measures have failed to control blood pressure (BP). Although drug treatment strategies to lower BP are well described, poor control rates of hypertension, even in the first world, suggest that more needs to be done to surmount the problem. A major issue is non-adherence to antihypertensive drugs, which is caused in part by drug intolerance due to side effects. More effective antihypertensive drugs are therefore required which have excellent tolerability and safety profiles in addition to being efficacious. For those patients who either do not tolerate or wish to take medication for hypertension or in whom BP control is not attained despite multiple antihypertensives, a novel class of interventional procedures to manage hypertension has emerged. While most of these target various aspects of the sympathetic nervous system regulation of BP, an additional procedure is now available, which addresses mechanical aspects of the circulation. Most of these new devices are supported by early and encouraging evidence for both safety and efficacy, although it is clear that more rigorous randomized controlled trial data will be essential before any of the technologies can be adopted as a standard of care.

El péptido natriurético endotelial de tipo C mantiene la homeostasis vascular / No disponible

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Lysophosphatidylcholine increases C-type natriuretic peptide expression in human vascular smooth muscle cells via membrane distortion.

C-type natriuretic peptide (CNP) inhibits the migration of vascular smooth muscle cells (VSMC) and related cell types induced by oxidized LDL and its major atherogenic component, lysophosphatidylcholine (LPC). CNP expression is increased in smooth muscle in atherosclerotic and restenotic lesions, but mechanisms underlying this increase have not been elucidated. We therefore investigated the role of LPC in CNP expression in human aortic VSMC. Both LDL and HDL elevated CNP transcript levels approximately 3-fold in VSMC, but not in endothelial cells. Increasing LPC in both VSMC and endothelial cells induced significant elevations in CNP transcript levels that were correlated with the degree of LPC-induced membrane distortion, and that were abolished by stabilizing cell membranes with cholesterol:methyl-beta cyclodextrin complexes or by chelating intracellular Ca2+ with BAPTA/AM. CNP up-regulation in HAoSMC by both LPC and lysophosphatidic acid was dependent on intact tyrosine kinase and protein kinase C (PKC)-signaling, whereas it was independent of these pathways in endothelial cells. LPC-induced up-regulation of CNP mRNA in human VSMC results from membrane damage and Ca2+ influx and subsequent tyrosine kinase and PKC signaling, suggesting a means by which vascular damage by ox-LDL and LPC could initiate CNP-mediated vasoprotection.

C-type natriuretic peptide inhibits leukocyte recruitment and platelet-leukocyte interactions via suppression of P-selectin expression.

The multifaceted process of immune cell recruitment to sites of tissue injury is key to the development of an inflammatory response and involved in the pathogenesis of numerous cardiovascular disorders. We recently identified C-type natriuretic peptide (CNP) as an important endothelium-derived mediator that regulates vascular tone and protects against myocardial ischemia/reperfusion injury. Herein, we investigated whether CNP inhibits leukocyte recruitment and platelet aggregation and thereby exerts a potential antiinflammatory influence on the blood vessel wall. We assessed the effects of CNP on leukocyte-endothelial cell interactions in mouse mesenteric postcapillary venules in vivo in animals with high basal leukocyte activation (endothelial nitric oxide synthase knockout mice, eNOS(-/-)) or under acute inflammatory conditions (induced by interleukin-1beta or histamine). CNP suppressed basal leukocyte rolling in eNOS(-/-) mice in a rapid, reversible, and concentration-dependent manner. These effects of CNP were mimicked by the selective natriuretic peptide receptor-C agonist cANF(4-23). CNP also suppressed leukocyte rolling induced by IL-1beta or histamine, inhibited platelet-leukocyte interactions, and prevented thrombin-induced platelet aggregation of human blood. Furthermore, analysis of human umbilical vein endothelial cells, leukocytes, and platelets revealed that CNP selectively attenuates expression of P-selectin. Thus, CNP is a modulator of acute inflammation in the blood vessel wall characterized by leukocyte and platelet activation. These antiinflammatory effects appear to be mediated, at least in part, via suppression of P-selectin expression. These observations suggest that endothelial CNP might maintain an anti-atherogenic influence on the blood vessel wall and represent a target for therapeutic intervention in inflammatory cardiovascular disorders.