Oxidative stress is an imbalance of ROS with a decrease in antioxidant defenses that contributes to hypertension in humans based on genetics and environment. Oxidative Stress, Inflammation, and Vascular Immune Dysfunction This two-part article will primarily review the role of nutrition and selected nutraceutical supplements, minerals, vitamins, anti-inflammatory agents, natural immune modulators, and antioxidants in the treatment of hypertension. 2–5, 11–14 The appropriate measurement, interpretation, and treatment of these nutrient deficiencies may effectively lower BP and improve ED, vascular and cardiac functional and structural abnormalities, and cardiovascular events. 2–5, 11–14 Certain nutrient deficiencies are more common in patients with hypertension than in the general population. Macronutrients and micronutrients are crucial in the regulation of BP and subsequent cardiovascular target organ damage (TOD). Infinite insults and the three finite vascular responses of inflammation, oxidative stress, and vascular immune dysfunction lead to endothelial dysfunction and cardiac and vascular dysfunction.Īs the BP increases, a bidirectional feedback occurs between the increased BP and the endothelial and vascular smooth-muscle dysfunction that exacerbates and perpetuates the cardiovascular functional and structural abnormalities. Infinite insults and the three finite vascular responses. These finite responses result in endothelial dysfunction and vascular smooth-muscle dysfunction, which leads to clinical cardiovascular disease.įigure 2. Infinite insults to the blood vessel result in only three finite responses of inflammation, oxidative stress, and vascular immune dysfunction. 2–5, 11–14 Significant functional and then structural microvascular impairment begins before elevations in BP in normotensive offspring of hypertensive parents. This consequently leads to vascular and cardiac hypertrophy, remodeling, functional and structural network rarefaction, decreased vasodilatory reserve, altered media-to-lumen ratio, stiffness, loss of arterial elasticity, fibrosis, increased pulse pressure, elevated pulse wave velocity (PWV), and increased augmentation index (see Fig. Cardiac smooth-muscle and vascular dysfunction and abnormalities of both microvascular function and structure precede the development of hypertension by decades. 2–5, 11–14 Hypertension is one of several responses of the blood vessel to endothelial dysfunction (ED). 2–5, 11–14 Hypertension is initially the expected and normal response to these infinite insults from the environment (including microbes, heavy metals, biochemical, biohumoral, and biomechanical issues, lipids, glucose, obesity, smoking, homocysteine, and many others) to the endothelium, but chronic dysregulation of this response associated with gene expression patterns leads to a complex series of vascular events in which the vascular system becomes an innocent bystander. 2–5, 11–14 These abnormalities coexist and interact with genetics, epigenetics, nutrient–gene expression, and other environmental and lifestyle factors. Hypertension is a consequence of micro- and macronutrient insufficiencies, abnormal vascular biology, reduced bioavailability of nitric oxide (NO), and the three finite vascular responses to vascular injury: inflammation, oxidative stress, and vascular immune dysfunction with activation for cell-mediated immunity (see Fig. 16, 17 However, some hypertensive patients either refuse to take drugs or prefer to treat with nutrition or nutritional supplements. 19 In numerous clinical trials, pharmacotherapy will control blood pressure (BP) and reduce stroke, CHD, myocardial infarction (MI), congestive heart failure (CHF), and renal disease. 1–19 There are >100 million people in the United States with hypertension based on new hypertension guidelines. Hypertension is one of the top five risk factors for coronary heart disease (CHD) and CVD and remains the most common reason for visits to primary care physicians, with antihypertensive drugs costing >U.S.$20 billion annually. Cardiovascular disease (CVD) remains the leading cause of death in the United States.
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