Vascular remodeling and antihypertensive therapy: the example of cicletanine.

Hypertension causes major structural vascular modifications including increase of wall:lumen ratio, vessel wall hypertrophy, and rarefaction of arterioles and small arteries. These structural alterations are accompanied with vascular dysfunctions. The stimuli responsible for this vascular remodeling are numerous and comprise physical, humoral, and locally synthetized factors. Among them, vasoactive substances such as vasoconstrictors (e.g., angiotensin II and endothelin) or vasodilating substances (e.g., prostacyclin and nitric oxide) may play a role as important as those of growth factors. The vascular protection afforded by antihypertensive drugs depends on their mode and their site of action and probably on their direct interference with the local hemodynamic and growth-affecting factors. This is well illustrated by cicletanine, a new antihypertensive agent that provides a good example of protection of the vasculature. This also emphasizes that vascular remodeling is important in hypertension and must be considered as an essential property of any new antihypertensive drug.