Reduction of Vessel Wall Inflammation in Hypertens

Authors: Thrall Graham Lip Gregory YH

Publish Date: 2006/07/01

Volume: 19, Issue: 7, Pages: 676-677

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Abstract

Graham Thrall Gregory YH Lip Reduction of Vessel Wall Inflammation in Hypertensive Patients Is Physical Activity the Answer American Journal of Hypertension Volume 19 Issue 7 July 2006 Pages 676–677 https//doiorg/101016/jamjhyper200511007Coronary heart disease CHD remains one of the major causes of mortality and morbidity in the western world The etiology of CHD is usually chronic and multifactorial and is increasingly seen as an inflammatory process Initiation of this inflammatory process may occurs through a continuum of endothelial activation dysfunction and damage leading to an increased expression of the cellular adhesion molecules CAM such as vascular cell adhesion molecule–1 VCAM1 intracellular adhesion molecule–1 ICAM1 and Eselectin Indeed subendothelial inflammation partly relies on the group of selectin molecules ie Eselectin mediating the initial rolling of leukocytes along the endothelium with VCAM1 and ICAM1 having an important role in their firm attachment and transendothelial migration Another inflammatory marker Creactive protein CRP is also thought to have an important role in subendothelial inflammation by promoting the expression of these CAMHypertension is recognized as a “classical” risk factor for the development and progression of CHD In addition various lifestyle variables such as low levels of physical fitness as well as physical inactivity are also being considered as independent risk factors for CHD Although the exact mechanism or mechanisms through which physical activity may reduce an individuals risk of CHD have yet to be fully elucidated it seems reasonable to hypothesize that it may at least in part be mediated through the reduction or prevention of vessel wall inflammationIn the current issue of this Journal Hjelstuen et al1 attempt to reinforce the previous epidemiologic evidence23 of an association between greater levels of physical activity and lower levels of various inflammatory markers sICAM sVCAM sEselectin hsCRP in a hypertensive cohort After univariate and multivariate regression analyses the authors demonstrate inverse relationships between physical fitness and hsCRP and between levels of physical activity and sEselectin These findings led the authors to speculate further on the ability of physical activity and fitness to reduce vessel wall inflammation ultimately leading to the lowering of an individuals cardiovascular riskThe positive findings from such epidemiologic studies have yet to be replicated convincingly in exercise training studies with only a few studies demonstrating a significant reduction in inflammatory markers CRP after an exercise training regimen lasting between 8 and 12 weeks45 Certainly small participant numbers eg n = 30 and gender differences in some studies may be confounding factors In addition to statistical power it is also plausible that certain training programs of certain intensity duration or frequency are more beneficial than others in eliciting a greater antiinflammatory responseIf physical activity is to be effectively implemented into an everexpanding “package of care” for individuals with classical risk factors for CHD further prospective data is required to elucidate fully the effect of exercise training on various markers of inflammation as well as to determine the optimal frequency duration and intensity of exercise required to produce the greatest reduction in vessel wall inflammation Furthermore inflammation is an important “driver” for the prothrombotic or hypercoagulable state associated with many cardiovascular disorders and because many CHD complications have thrombosisrelated pathophysiologies the parallel impact on clinical outcomes merits further study Finally many drugs commonly used in the treatment of CHD such as angiotensinconverting inhibitors and statins have antiinflammatory properties and it would be increasingly difficult to dissect out which component of a socalled “package of care” including drugs exercise and lifestyle changes would most effectively alter the inflammatory state in CHD patients Clearly further study into the effects of physical and perhaps mental stress on the inflammatory and thrombotic risk in CHD is needed

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