PHARMACOLOGY OF CARDIAC AND VASCULAR REMODELING

Cardiovascular diseases involve changes in the structure of the heart and blood vessels. Normal structure is maintained by a sophisticated s et of mechanical and cellular ''checks and balances.'' A disturbance o f these checks and balances induces a remodeling process. The most dis tinguished features of this process are phenotypic modulation of vario us cell types in the cardiovascular system; cellular hyperplasia and h ypertrophy; and extracellular matrix production, deposition, and degra dation. Optimal pharmacotherapy of cardiovascular diseases should be a imed at correcting structural abnormalities in the heart and blood ves sels. This goal can be achieved by influencing mechanical stresses on the cardiovascular system or by interfering with the chemical mediator s of the remodeling process. Many existing groups of cardiovascular dr ugs, such as angiotensin-converting enzyme inhibitors, calcium-antagon ists, alpha- and beta-adrenoceptor antagonists, and antithrombotic dru gs, influence cardiovascular remodeling. New approaches involve the de velopment of drugs acting on peptidergic mediators of cardiovascular r emodeling.