Innovative Pharmacological Strategies Targeting Endothelial Dysfunction and Vascular Remodeling in Hypertension Management: A Narrative Review

Background Hypertension is a worldwide health issue and an independent risk factor for cardiovascular disease. Endothelial dysfunction is an important mechanism for its pathogenesis, thus compromising vascular homeostasis and causing vascular remodeling. It is supported by reduced availability of nitric oxide, increased oxidative stress, and chronic inflammation, all of which contribute to hypertension as well as cardiovascular morbidity. Purpose The present narrative review is focused on exploring new pharmacological interventions to target endothelial dysfunction and vascular remodeling in the treatment of hypertension. The review brings molecular mechanisms to the forefront. It discusses new therapeutic drugs to target the reversal of endothelial function and improve vascular health, ultimately resulting in better control of hypertension. Materials and Methods A narrative review of the literature was performed, including studies from preclinical studies, clinical trials, and new pharmacological advances. The review is focused on modulation of the nitric oxide pathway, anti-oxidant therapy, angiotensin receptor blockers, and new therapies for oxidative stress. New endothelial progenitor cell function therapies, hydrogen sulfide (H 2 S) donors, and nanoparticle-based drug delivery systems were discussed. Results Recent evidence clearly shows that pharmacologic therapy for reversing endothelial dysfunction is effective for treating hypertension. H 2 S donors reduce oxidative stress and increase vascular relaxation, and endothelial progenitor cells are explored for vascular repair. Nanoparticles enable targeted delivery of drugs into endothelial cells, with increased therapeutic impact. Further, nitric oxide generation modulating drugs, such as angiotensin receptor blockers, have been reported to improve vascular function and control hypertension. Conclusion Pharmacotherapy for endothelial dysfunction is extremely promising in improving hypertension management by targeting the very pathogenesis of the disease. Further research and clinical trials are required to improve these therapies further and establish their long-term clinical benefits.