The mechanisms of the extracellular matrix remodeling of myocardium among patients with hypertension

Abstract

Annotation. The present review article highlights the central mechanisms that contribute to the extracellular matrix remodeling in the myocardium among patients with hypertension. Based on the scientometric databases Web of Science, Scopus, and PubMed, a retrospective analysis of the literature issued in 2010-2022 on this specific topic was conducted. After reviewing the article abstracts and getting acquainted with their full text, we selected 30 sources. The search results suggest that under physiological conditions, collagen ensures structural integrity by preventing excessive stretching of cardiomyocytes. It was established in the course of the research that progressive vascular fibrosis occurs due to excessive collagen synthesis relative to its degradation by metalloproteinases. Metalloproteinases play a central role in the exchange of connective tissue proteins. Cytokinins such as tumor necrosis factor alpha and interleukin-1β contribute to the accumulation of collagen in the intercellular space, aldosterone being another contributor to the process. It has been noted that hypertensive disease is associated with high activity of angiotensin-II, which regulates the expression of β-transforming growth factor and has pro-fibrotic properties. Biological molecules of catecholamines, as well as molecules of aldosterone and angiotensin-II, affect the activity of MMP by suppressing NO activity in the vessel wall. An understanding of various pathophysiological mechanisms involved in hypertension leading to vascular dysfunction and myocardial remodeling as well as changes in the extracellular matrix of the myocardium can prove to be essential for identifying critical pharmacological targets. The priority of prescribing specific groups of antihypertensive drugs remains uncertain at the moment, but special attention is paid to their effect on the inhibition and reversal of the development of myocardial and vascular fibrosis. Thus, the study of the activity of enzymes of the metalloproteinase family is promising for clinical studies in hypertension.