Endothelial dysfunction in hypertension: From bench to bedside and future directions

Introduction: The vascular endothelium plays an important rule in vascular homeostasis, tone and as a consequence, vascular health. Impairment in endothelial function or endothelial dysfunction translates to increased vascular tone and possibly to high blood pressure. Although is still debatable whether endothelial dysfunction remains a cause or consequence of essential hypertension, reversal of this target organ damage undoubtedly leads to improved cardiovascular prognosis. Not unreasonably, reversal of endothelial dysfunction has become therefore an ambitious treatment target. In this article, after exploring and providing evidence for the presence of endothelial dysfunction in hypertension, we also provide a systemic literature search review of endothelial dysfunction reversal in essential hypertension. Methods: We conducted a MEDLINE, EMBASE etc. search of all of published studies referring to endothelial dysfunction reversal or improvement in hypertension from 1989 to 2012. Studies involving placebo were also included. Results: We identified several pharmacologic and non-pharmacologic approaches favourably affecting endothelial function. Interestingly, blood pressure reduction per se did not affect vascular function. Modulators of the renin-angiotensin-aldosterone system (RAAS) appeared to have a consistent and a powerful effect in ameliorating or even reversing endothelial dysfunction in comparison to other antihypertensive agents for the same blood pressure control. Conclusions: Reducing blood pressure without specific antihypertensive drugs does not seem to improve endothelial dysfunction. Modulators of the RAAS appear to have a long lasting beneficial effect on endothelial function perhaps providing a mechanistic link to their favourable effects on hypertensive cardiovascular prognosis.