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Sains Malaysiana 53(12)(2024): 3365-3376
http://doi.org/10.17576/jsm-2024-5312-19
A
Double-Edged Sword Effect of Angiogenesis in
Hypertension: A Review
(Kesan Pedang Bermata Dua
Angiogenesis dalam Hipertensi: Suatu Tinjauan)
Noor Hasila, A.D.1, Nur Syahidah, N.H.1, Adila, A.H.2, Farinawati Yazid3 & Nur Najmi, M.A.1,*
1Programme of Biomedical Science,
Centre of Toxicology & Health Risk Studies, Faculty of Health Sciences,
Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur,
Malaysia
Diserahkan:
30 Mei 2024/Diterima: 29 Oktober 2024
Abstract
Hypertension, commonly known as high blood pressure, is a serious
medical condition that significantly raises the risk of heart, brain, kidney,
and blood vessel diseases. It remains one of the leading causes of morbidity
and mortality worldwide, with its mechanisms still not fully understood. One
emerging area of interest is the role of angiogenesis, the formation of new
blood vessels, which is regulated by a delicate balance between pro- and
anti-angiogenic modulators, including angiogenic factors, extracellular matrix
proteins, adhesion receptors, and proteolytic enzymes. Disruption of this
balance can lead to abnormal angiogenesis, potentially contributing to
hypertension, as angiogenic growth factors are critical in maintaining vascular
structure. If left untreated, high blood pressure damages capillaries and
microvessels, accelerating the process of vascular rarefaction. Notably,
microvascular rarefaction may occur independently of changes in blood pressure,
indicating its potential role as a primary factor in hypertension progression.
The ‘double-edged sword effect’ describes the paradoxical impact of both pro-
and anti-angiogenic therapies, where either type of drug can induce
hypertension, highlighting the dual nature of angiogenic regulation in vascular
health. Given the rising use of angiogenesis-modulating therapies in treating
various diseases, therapy-induced hypertension is expected to become more
prevalent. This review was conducted to address the growing need to understand
this dual effect of angiogenic therapies, the mechanisms underlying
hypertension development, and the critical importance of early detection and
long-term management of hypertension in patients undergoing such treatments.
Keywords:
Angiogenesis;
anti-angiogenic; hypertension; microvascular rarefaction; pro-angiogenic
Abstrak
Hipertensi, yang dikenali sebagai tekanan darah tinggi, adalah keadaan
perubatan serius yang secara signifikan meningkatkan risiko penyakit jantung,
otak, buah pinggang dan saluran darah. Ia kekal sebagai salah satu punca utama
morbiditi dan mortaliti di seluruh dunia dengan mekanismenya yang masih belum
difahami sepenuhnya. Salah satu bidang yang semakin mendapat perhatian ialah
peranan angiogenesis, iaitu pembentukan saluran darah baharu yang dikawal oleh
keseimbangan halus antara modulator pro-angiogenik dan anti-angiogenik,
termasuk faktor angiogenik, protein matriks ekstrasel, reseptor adhesi dan
enzim proteolitik. Gangguan pada keseimbangan ini boleh menyebabkan
angiogenesis yang tidak normal, berpotensi menyumbang kepada hipertensi, kerana
faktor pertumbuhan angiogenik adalah penting dalam mengekalkan struktur
vaskular. Jika tidak dirawat, tekanan darah tinggi boleh merosakkan kapilari
dan mikrovesel, mempercepatkan proses kekurangan vaskular. Kekurangan
mikrovesel ini juga mungkin berlaku secara bebas daripada perubahan tekanan
darah, menunjukkan peranannya sebagai faktor utama dalam perkembangan
hipertensi. Kesan ‘pedang bermata dua’ menggambarkan impak paradoks kedua-dua
terapi pro- dan anti-angiogenik dengan kedua-dua jenis ubat boleh menyebabkan hipertensi,
menonjolkan sifat dwi pengawalan angiogenik dalam kesihatan vaskular.
Memandangkan penggunaan terapi yang memodulasi angiogenesis semakin meningkat
untuk merawat pelbagai penyakit, hipertensi yang disebabkan oleh terapi
dijangka menjadi lebih kerap. Kajian semula ini dijalankan untuk menangani
keperluan yang semakin meningkat dalam memahami kesan dwi terapi angiogenik,
mekanisme yang mendasari perkembangan hipertensi, serta kepentingan kritikal
pengesanan awal dan pengurusan jangka panjang hipertensi pada pesakit yang
menjalani rawatan sedemikian.
Kata
kunci: Angiogenesis; anti-angiogenik; hipertensi; kekurangan mikrovaskular; pro-angiogenik
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