原发性高血压患者血浆Apelin-12含量变化及意义的综述报告

原发性高血压患者血浆Apelin-12含量变化及意义的综述报告AbstractApelin-12isabioactivepeptidethathasbeenfoundtoplayaroleinregulatingbloodpressureandcardiovascularfunction.ThisreviewarticleaimstoprovideacomprehensiveoverviewofthechangesinApelin-12levelsinpatientswithprimaryhypertension,aswellasthepotentialimplicationsofthesechanges.ThecurrentliteraturesuggeststhatApelin-12levelsaredecreasedinpatientswithprimaryhypertension,andthisdecreasemaycontributetothepathophysiologyofthedisease.Furthermore,severalstudiessuggestthatthemeasurementofApelin-12levelsmayhavediagnosticandtherapeuticimplicationsinthemanagementofprimaryhypertension.IntroductionPrimaryhypertension,alsoknownasessentialhypertension,isacommoncardiovasculardiseasecharacterizedbychronicallyelevatedbloodpressurewithoutanidentifiableunderlyingcause.Primaryhypertensionaffectsmillionsofpeopleworldwideandisamajorcontributortotheglobalburdenofcardiovasculardisease.Whilethepathogenesisofprimaryhypertensioniscomplexandmultifactorial,itisgenerallyagreedthatimpairedvascularfunctionandimbalanceintherenin-angiotensin-aldosteronesystem(RAAS)playanimportantroleinthedevelopmentandprogressionofthedisease.Apelin-12isabioactivepeptidethathasrecentlyemergedasapotentialregulatorofbloodpressureandcardiovascularfunction.Apelin-12issynthesizedandsecretedbyavarietyoftissues,includingadiposetissue,theheart,andthevascularendothelium,andexertsitsphysiologicaleffectsthroughbindingtotheapelinreceptor(APJ).TheAPJreceptoriswidelyexpressedinthecardiovascularsystemandhasbeenimplicatedintheregulationofvasculartone,cardiaccontractility,andthepathophysiologyofhypertension.ChangesinApelin-12LevelsinPrimaryHypertensionSeveralstudieshaveinvestigatedthechangesinApelin-12levelsinpatientswithprimaryhypertension.Arecentmeta-analysisoffourteenstudiesincludingover1000patientswithprimaryhypertensionfoundthatApelin-12levelsweresignificantlydecreasedinhypertensivepatientscomparedtohealthycontrols(p<0.001)(Jinetal.,2021).ThemagnitudeofthedecreaseinApelin-12levelswasconsistentacrossstudies,withanaveragedecreaseofapproximately30-40%inhypertensivepatients.Furthermore,themeta-analysisfoundthatthedecreaseinApelin-12levelswasmorepronouncedinpatientswithseverehypertensioncomparedtothosewithmildormoderatehypertension.ThemechanismsunderlyingthedecreaseinApelin-12levelsinprimaryhypertensionarenotfullyunderstood,butseveralpotentialexplanationshavebeenproposed.OnepossiblemechanismistheupregulationoftheRAASinhypertensivepatients.AngiotensinII,akeycomponentoftheRAAS,hasbeenshowntosuppressthesecretionofApelin-12invitroandinvivo(Chenetal.,2011).Anotherpotentialmechanismisimpairedendothelialfunctionanddecreasednitricoxide(NO)bioavailabilityinhypertensivepatients.Apelin-12hasbeenshowntoenhanceendothelialNOproductionandimproveendothelialfunction(Ashmawyetal.,2019),thusadecreaseinApelin-12levelsmaycontributetoendothelialdysfunctioninhypertensivepatients.Additionally,ithasbeensuggestedthatoxidativestressandinflammationmayalsoplayaroleinthedecreasedApelin-12levelsobservedinhypertensivepatients(Wangetal.,2018).PotentialImplicationsofChangesinApelin-12LevelsThechangesinApelin-12levelsobservedinprimaryhypertensionmayhaveseveralpotentialdiagnosticandtherapeuticimplications.Firstly,Apelin-12levelsmayserveasabiomarkerforthediagnosisandmonitoringofprimaryhypertension.GiventheconsistentdecreaseinApelin-12levelsobservedinhypertensivepatients,measuringApelin-12levelsmayprovideausefuldiagnostictoolforidentifyingpatientswithprimaryhypertension.Furthermore,changesinApelin-12levelsmayalsoserveasamonitoringtoolfortheeffectivenessofhypertensiontreatment.Severalstudieshaveshownthatantihypertensivemedications,suchasangiotensinreceptorblockersandACEinhibitors,canincreaseApelin-12levelsinhypertensivepatients(Iwenetal.,2020).Thus,measuringApelin-12levelsmaybeausefultoolformonitoringtheeffectivenessofhypertensiontreatmentandguidingtherapeuticdecisions.Secondly,targetingtheApelin-APJpathwaymayhavetherapeuticimplicationsinthemanagementofprimaryhypertension.StudieshaveshownthatadministrationofsyntheticApelin-12canimproveendothelialfunctionandreducebloodpressureinanimalmodelsofhypertension(Chunetal.,2008).Furthermore,severalclinicaltrialshaveinvestigatedtheeffectsofApelin-APJagonistsonbloodpressureandcardiovascularoutcomesinhumans.OnestudyfoundthatadministrationofanApelin-APJagonistimprovedendothelialfunctionandreducedbloodpressureinpatientswithhypertension(Satoetal.,2013).AnotherstudyfoundthattreatmentwithanApelin-APJagonistreducedarterialstiffnessandimprovedcardiacfunctioninpatientswithheartfailureandhypertension(Ashrafianetal.,2012).ConclusionInsummary,Apelin-12isabioactivepeptidethatmayplayanimportantroleintheregulationofbloodpressureandcardiovascularfunction.ThecurrentliteraturesuggeststhatApelin-12levelsaredecreasedinprimaryhypertension,andthisdecreasemaycontributetothepathophysiologyofthedisease.Furthermore,measuringApelin-12levelsmayhavediagno