Absence of vascular remodelling in a high angiotensin-II state (Bartter's and Gitelman's syndromes): implications for angiotensin II signalling pathways

Background. Angiotensin II (Ang II) is a powerful proinflammatory cytokine and growth factor that activates NF-κB, as well as NAD(P)H oxidase, and thus is a key factor for the induction and progression of cardiovascular diseases. Our previous studies have shown high Ang II and high blood pressure-driven proatherogenic remodelling in an animal model. To further explore Ang II in proatherogenic vascular remodelling independent of blood pressure, we used Bartter’s/Gitelman's syndrome (BS/GS) patients given their elevated plasma Ang II, yet normo/hypotension, because extensive mechanistic studies in these patients suggest they are a good model to explore Ang II-mediated signalling.Methods. The study evaluated BS/GS patients for nitric oxide-dependent (FMD) and -independent vasodilation and intima-media thickness (IMT) of the carotid arteries compared with healthy subjects and essential hypertensive patients.Results. The results showed the absence of IMT growth in BS/GS patients as cumulative mean-IMT and mean maximum-IMT levels in BS/GS did not differ from normotensives: 0.58 ± 0.09 mm versus 0.60 ± 0.09 and 0.67 ± 0.09 versus 0.70 ± 0.13 respectively, P = ns, but were significantly lower compared with hypertensive patients: 0.69 ± 0.13, P < 0.046 and 0.85 ± 0.19, P < 0.018, respectively. FMD was increased in BS/GS versus hypertensives or normotensive controls (10.8 ± 2.7% versus 6.5 ± 2.3 and 8.7 ± 1.9, P < 0.002 respectively) while endothelium-independent dilation did not differ (10.2 ± 3.6% versus 7.2 ± 1.9 and 8.2 ± 3.3, P = ns) between groups.Conclusions. Our study in BS/GS provides to our knowledge the first clinical data that point to a direct proatherogenic role for Ang II. However, because the data are derived from findings in BS/GS and therefore are indirect, further studies in this and other models using more direct approaches should be pursued to demonstrate a direct proatherogenic effect of Ang II as well as further studies on Ang II type 2 receptor (AT2R) signalling that the spectrum of findings of this and other studies indicate as involved in the lack of vascular remodelling.