Nitric Oxide as a Target for Hypertension Management : a Review

High blood pressure is well-established as a leading cause of stroke, ischemic heart disease, and cardiovascular disease. Globally cardiovascular disease accounts for approximately 17 million deaths a year, nearly one third of the total. A number of pharmaceutical agents are available for initial treatment of high BP. These include older molecules such as diuretics and beta-blocking agents, and newer molecules such as dihydropyridine calcium channel blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and direct acting vasodilators. Comprehensive hypertension management focuses on reducing overall cardiovascular risk and should be the preferred approach for initial management of hypertension.

Nitric oxide is a gaseous signaling molecule that regulates various physiological and pathophysiological responses in the human body. Nitric oxide is a gaseous lipophilic free radical which reacts with various molecules to cause pleiotropic effects and it is generated by three distinct isoforms of nitric oxide synthase. The physiologic effects include circulation and blood pressure, platelet function, host defense, and neurotransmission in central nervous system and in peripheral nerves.

The etiology of the association between impaired nitric oxide bioactivity and hypertension is complex, however, and has not been fully elucidated. Important mechanisms of hypertension and cardiovascular disease, in which impaired nitric oxide bioactivity plays a major role, include arterial stiffness and increased systolic pulse wave velocity, and possibly chronic sympathetic nervous system activation to be investigated in-depth.

NO plays a vital role in a wide variety of pathophysiological and biochemical reactions. Nitric oxide is a critically important mediator in the pathophysiology of different cardiac diseases. Nitric oxide has been identied as one of the key targets for novel therapeutic interventions to minimize irreversible tissue damage associated with complications of hypertension and other cardiovascular disorders.