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The protective effects of ginsenoside Rg1 against hypertension target-organ damage in spontaneously hypertensive rats
- Hui Chen†1, 2,
- Jun Yin†2,
- Yanpin Deng1,
- Min Yang1,
- Lingling Xu1,
- Fukang Teng1, 2,
- Defang Li1,
- Yufan Cheng3,
- Sha Liu4,
- Dong Wang2,
- Tingting Zhang1, 2,
- Wanying Wu1,
- Xuan Liu1,
- Shuhong Guan1,
- Baohong Jiang1Email author and
- Dean Guo1Email author
© Chen et al.; licensee BioMed Central Ltd. 2012
Received: 20 July 2011
Accepted: 3 April 2012
Published: 25 April 2012
Although a number of medicines are available for the management of hypertension, the organ damage induced by hypertension is not resolved. The aim of this study was to investigate the protection of ginsenoside Rg1 (Rg1) against vascular remodeling and organ damage in spontaneously hypertensive rats (SHR).
Male SHR were treated with 5, 10 or 20 mg/kg Rg1 through intraperitoneal injection per day for 1 month. SHR or Wistar-Kyoto rats (WKY) receiving vehicle (saline) was used as control. Blood pressure detection and pathological stain, transmission electron microscope, immunohistochemical assay were used to elucidate the protection of Rg1.
Blood pressures were not different between control SHR rats and Rg1 treated SHR rats, but Rg1 improved the aortic outward remodeling by lowering the lumen diameter and reducing the media thickness according the histopathological and ultrastructural detections. Rg1 also protected the retinal vessels against inward remodeling detected by immunohistochemical assay. Furthermore, Rg1 attenuated the target heart and kidney damage with improvement on cardiac and glomerular structure.
These results suggested that Rg1 held beneficial effects on vascular structure and further protected against the organ-damage induced by hypertension. These findings also paved a novel and promising approach to the treatment of hypertensive complications.
Recent evidence suggests that the average blood pressure (BP) in children and adults is rising in the last two decades . Hypertension is becoming one of the main risk factor for cardiovascular and renal vascular disease, and also for mortality around the world . Although the blockers of calcium channel and inhibitors of rennin-angiotensin system are widely applied for clinical therapy, the target-organ damage accompanied by hypertension is still not solved. Therefore, new therapeutic strategies and new medicines to attenuate hypertension-complications are urgently needed .
Panax notoginseng, one of the most frequently used traditional Chinese medicine, is well known for its efficacy in promoting blood circulation, ameliorating pathological hemostasis, alleviating pain [4–7]. The main active components of Panax notoginseng include more than 30 different types of saponins, among which Rg1and Rb1 are found in the highest content. A number of clinical and physiological effects of Rg1 have been described recently, such as inhibition of tubular epithelial to myofibroblast transition , improvement of myocardial dysfunction in rats with burn injuries , amelioration of hepatic microcirculatory disturbances , anti-hyperglycemic activity , and improvement of endothelial cell function . Recently, Rg1 has been identified to be an angiogenic factor, which can induce neovascularizaton in vivo and promote proliferation and tubulogenesis of endothelial cells in vitro [13–15]. Further mechanism research revealed that Rg1 could activate phosphatidylinositol-3 kinase Akt pathway, inhibit P38 MARK pathway . Recent studies have demonstrated the beneficial effects of Rg1 on improvement of cardial and renal function .
Thus, we carried out the present study in SHR rats to test our hypothesis that Rg1 may inhibit the vascular remodeling and targeted-organ damage induced by hypertension.
Animals and Rg1 treatment
2 month old male Wistar-Kyoto rats (WKY, 280–300 g) and spontaneous hypertension rats (SHR, 280–300 g) were purchased from Shanghai Center of Experimental Animals, Chinese Academy of Sciences. Rats were acclimatized in temperature and humidity-controlled rooms with a 12-h dark/light cycle throughout the study. After 8 week high salt diet, WKY rats that treated by saline were used as normal control (WKY, n = 10). SHR rats were randomly divided into four groups (10 per group): rats that treated by saline were used as hypertension model (SHR); rats in the other three groups were treated by 5 mg/kg Rg1 (SHR-Rg1(5)), 10 mg/kg Rg1 (SHR-Rg1(10)) or 20 mg/kg Rg1 (SHR-Rg1(20)). Saline or Rg 1 (dissolved in saline) were given once a day intraperitoneally. The purity of Rg1 that purchased from Shanghai Yousi Bio-Tech Co., Ltd. was more than 99% evaluated by high-performance liquid chromatography ( Additional file 1: Figure S1) and the chemical structure of Rg1 was elucidated by 13 C NMR ( Additional file 2: Figure S2 Additional file 3: Figure S3), which is in agreement with those previous report . 8.0% high salt diet was fed during the whole research, and saline or Rg1 was given from the ninth week of experiment for 4 weeks. The whole experiment protocol was shown in Additional file 4 Figure S4. Experimental procedures were approved by the institute animal ethics committee (SIMM-AE-GDA-2010-05) and were in accordance with the National Institute of Health guidelines.
Measurement of blood pressure in conscious rats
Systolic blood pressure (SBP) and diastolic pressure (DBP) were measured 0.5 h after the administration of Rg1 at the indicated time ( Additional file 4: Figure S4) using the tail-cuff method. Briefly, the rats were placed in a restrainer with heating pad. The blood pressure was continuously recorded by a tail-cuff apparatus (ALC-NIBP, Shanghai Alcott Biotech Co., China) that was controlled with a computer after stabilizing at 37°C for at least 10 min.
Measurements of hemodynamic parameters
The rats were anesthetized, and a Mikro-tipped SPR-320 catheter (Millar Instruments Inc) was inserted through the right carotid artery into left ventricle. Heart rate, mean arterial pressure (MAP), left ventricular systolic pressure (LVSP), end-diastolic pressure (EDP) of rats were recorded by PowerLab 8/30 instrument (ADInstruments, Australia). Maximal rate of pressure development for contraction (+dP/dtmax) and maximal rate of pressure development for relaxation (−dP/dtmax) were all calculated from the continuously collected pressure signal.
After the treatment of Rg1, ascending aorta, heart and kidney of each rat were weighed, and then fixed by 4% neutral-buffered paraformaldehyde for 24 h. Heart index was calculated as that the heart weight was divided by body weight. All the specimens were paraffin-embedded, cut at 5 μm and were stained with haematoxylin and eosin. Photomicrographs were taken using an Olympus BX51 microscope plus Olympus DP71 CCD camera (Olympus Corporation, Japan). Software Image-Pro Plus version 6.0 was used to detect lumen diameter and media thickness of aorta. The aortic lumen diameter was calculated as the mean of the inner diameters through the center of vascular circle, and the media thickness defined as the distance between the internal and external elastic lamina. At least 16 values were measured from the points distributed evenly on every aorta. Paraffin-embedded slices were also stained with 0.1% picric sirius red (Sigma-Aldrich Inc, St Louis, USA) for fibrosis detection.
Immunohistochemical detection on retinal vessels
Rat eyes were fixed in 4% neutral-buffered paraformaldehyde and the solution was replaced every two days. Before retinal dissection, the eyes were washed by running water for 20 mins. Retinas were dissected, flattened on slides, washed by PBS, then incubated in PBS containing 0.5% Triton X-100 and 10% normal goat serum for 1 h at room temperature. After a short rinse with PBS, retinas were incubated with the α-SMA-Cy3 (Sigma-Aldrich, Germany) and lectin-FITC (Sigma-Aldrich, Germany) at 1000 times dilution at 37°C for 1 h. Retinal artery could be stained by both α-SMA-Cy3 and lectin-FITC positively. Photomicrographs were taken with Olympus BX51 fluorescence microscope and retinal vessel diameter was directly measured at the point of 0.5 mm from the middle of the arteriole.
Transmission electron microscopy
Aorta, heart, kidney samples were dissected, cut into small pieces and fixed with 2.5% glutaraldehyde in 0.1 M sodium cacodylate buffer for 2 h in 4°C. The specimens were then rinsed, post-fixed in cacodylate -buffered 2% osmium tetroxide, and embedded as monolayers in LX-112 (Ladd Research Industries, USA). Ultrathin sections were contrasted with uranyl acetate followed by lead citrate and observed with a Tecnai 12 BioTwin transmission electron microscope (Philips Electronic Instruments, USA). Random sections were selected for analysis by an electron microscopy technician blinded to the treatments.
All quantitative values are given as mean ± S.E. Mean values of data from different treatment groups were compared using one-way ANOVA. After confirming the equal variances, unpaired Student’s t-test was used to compare difference between means of two groups using SigmaPlot software. P < 0.05 was considered to be statistically significant.
No influence of Rg1 on blood pressure
Effects of Rg1 on blood pressure
133.7 ± 2.2
184.5 ± 3.4###
186.0 ± 2.4###
183.5 ± 3.3###
183.0 ± 4.2###
97.5 ± 2.0
139.0 ± 3.0###
138.0 ± 2.4###
139.1 ± 2.8###
133.8 ± 3.9###
360.6 ± 14.0
393.6 ± 12.5#
366.7 ± 13.7
412.6 ± 8.9
433.5 ± 9.3*
111.5 ± 6.3
170.1 ± 16.7###
181.6 ± 14.0###
175.4 ± 37.4###
193.7 ± 10.4###
6.1 ± 1.7
7.5 ± 3.0
3.1 ± 1.0
4.8 ± 3.9
5.5 ± 1.8
120.9 ± 7.1
207.1 ± 17.9###
213.7 ± 21.1###
224.3 ± 35.4###
217.5 ± 16.8###
+dP/dtmax (mm HgS-1)
8661.1 ± 717.7
11735.7 ± 635.8##
13063.6 ± 470.8###
12651.9 ± 803.0##
12636.7 ± 514.7###
-dP/dtmax (mm HgS-1)
−7514.6 ± 626.0
−11272.1 ± 872.8##
−12410.0 ± 595.7###
−11330.2 ± 722.8###
−11464.1 ± 534.8###
2.9 ± 0.2
3.9 ± 0.05#
3.8 ± 0.08#
3.8 ± 0.07#
3.6 ± 0.06# **
Rg1 reduces aortic remodeling
Rg1 reduces retinal vascular remodeling
Rg1 protects the ultra-structural integrity of aorta
Rg1 protects against the impairment of hypertensive heart and kidney
Rg1 protects against cardio-fibrosis induced by hypertension
Rg1 protects the ultra-structure integrity of heart and kidney of SHR
This study assessed the protective effects of Rg1 on hypertension target-organ damage in SHRs. The main findings are as follows: (i) Rg1 attenuated the outward remodeling of aorta. (ii) Rg1 decreased the inward remodeling of small artery. (iii) Rg1 improved the cardial hypertrophy and fibrosis. (iv) Rg1 maintained the normal structure of kidney.
Numerous studies have demonstrated that high salt intake causes adverse structural and functional effects in the cardiovascular system [20, 21]. Excessive salt intake is often associated with an increase in arterial pressure and, consequently, increases in arterial pressure may partially mediate salt-related adverse effects . In addition to the well-admitted effect of sodium on blood pressure, several clinical and experimental observations are in favour of non-pressure-related effects of salt that could contribute to its influence on cardiovascular outcome . High salt intake caused hypertrophic response, then concentric cardiac-remodeling . High dietary salt led to widespread fibrosis and increased TGF-β1 in the heart and kidney in normotensive and hypertensive rats, suggesting that excessive salt intake may be an important direct pathogenic factor for cardiovascular disease .
Up to now, cardiovascular disease is still the most important factor that affects people’s life, especially the hypertension [1, 2, 25]. To delay or prevent hypertension target-organ, containing heart failure and renal failure, is essential to improve patient’s quality of life . In agreement with previous reports that the most common change found in large arteries in hypertension is an “outward hypertrophic remodeling”, we detected the increased lumen diameter and wall thickness in SHR compared with WKY. In hypertensive large arteries, these changes appear to be the consequence of cellular hypertrophy, cell hyperplasia, increased deposition of fibrillar or nonfibrillar matrix, or from a combination of these events [27–30]. Remodeling of the small resistance arteries may involve an inward or an outward remodeling [19, 31]. In the present study, we confirmed an inward remodeling in small retinal arteries of SHR compared with WKY. Rg1 treatment not only reduced the outward remodeling of large conductance arteries but also attenuated the inward remodeling of small resistance arteries, although no regulation of Rg1 on blood pressure was found. These results agree with those of other reports that ACE inhibitors are effective in controlling or reversing vascular remodeling, not depending on the anti-hypertensive effects [32, 33].
The final goal of novel therapy of hypertension is not only to normalize the blood pressure level but also to prevent end-organ damage, such as cardiac hypertrophy and renal dysfunction [26, 34]. Altered retinal arteries diameter has also been demonstrated to be associated with heart failure, suggesting that evaluation of the retinal microvasculature may be a useful predictor of target organ damage [35, 36]. Collagen deposition is the risk factor which plays an important role in development of organ failure, such as heart failure and renal failure . The myocardial matrix becomes less distensible, as the formation of the adducts in collagen resists normal turnover. Therefore, monitoring cardiac fibrosis and use of medicines that reverse collagen accumulation might represent a novel opportunity to alter the natural history of hypertensive heart disease.
In the previous report, the presence of myocardial hypertrophy and fibrosis in SHR was obvious at early stage, but the diastolic and systolic dysfunction did not occur until 13 to 18 months of age of SHR . This finding is in consistence with our present study. It is hopeful that the improvement of Rg1 on cardiac function could be detected by elongation of Rg1 treatment or selection of SHR more than 13 month old, basing on the anti-fibrotic effects of Rg1 at the early stage of hypertension.
We detected heart rate on conscious SHR during the experiment using tail-cuff apparatus, and up-regulation of Rg1 on heart rate was found. Increase of heart rate induced by Rg1 should be considered as a side effect in cardiovascular disease. Shen et al. have reported that Rg1 down-regulated heart rate in anesthetized mice treated by glutamate . The difference between our report and Shen et al. maybe derive from the different species used, suggesting the increase of Rg1 on heart rate may not occur if animal model other than SHR was used. Different biological response induced by extract from herbs between species was also reported [40, 41]. Further study was necessary to clarify the effects of Rg1 on heart rate on different species and the underlying mechanism.
In summary, Rg1 performed cardiac and renal protection with inhibition of vascular remodeling not only on large conductance artery but also on small resistance artery. The unique structure and efficiency of Rg1 afford a great deal of potential for further optimization of this natural compound into therapeutics for hypertension related abnormalities.
This work was supported by National Natural Science Foundation of China grant (81173587), partly supported by the Major Projects of Knowledge Innovation Program of the Chinese Academy of Sciences (KSCX2-YW-R-166).
- Cutler JA, Sorlie PD, Wolz M, Thom T, Fields LE, Roccella EJ: Trends in hypertension prevalence, awareness, treatment, and control rates in United States adults between 1988–1994 and 1999–2004. Hypertension. 2008, 52 (5): 818-827. 10.1161/HYPERTENSIONAHA.108.113357.View ArticlePubMedGoogle Scholar
- Ezzati M, Lopex AD, Rodgers A, Vander Hoorn S, Murray CJ: Selected major risk factors and global and regional burden of disease. Lancet. 2002, 360 (9343): 1347-1360. 10.1016/S0140-6736(02)11403-6.View ArticlePubMedGoogle Scholar
- Yamori Y: Implication of hypertensive rat models for primordial nutritional prevention of cardiovascular diseases. Clin Exp Pharmacol Physiol. 1999, 26 (7): 568-572. 10.1046/j.1440-1681.1999.03085.x.View ArticlePubMedGoogle Scholar
- Dong TT, Cui XM, Song ZH, Zhao KJ, Ji ZN, Lo CK, Tsim KW: Chemical assessment of roots of Panax notoginseng in China: regional and seasonal variations in its active constituents. J Agric Food Chem. 2003, 51 (16): 4617-4623. 10.1021/jf034229k.View ArticlePubMedGoogle Scholar
- Ng TB: Pharmacological activity of sanchi ginseng (Panax notoginseng). J Pharm Pharmacol. 2006, 58 (8): 1007-1019.View ArticlePubMedGoogle Scholar
- Sun HX, Pan HJ, Pan YJ: Haemolytic activities and immunologic adjuvant effect of Panax notoginseng saponins. Acta Pharmacol Sin. 2003, 24 (11): 1150-1154.PubMedGoogle Scholar
- Gillis CN: Panax ginseng pharmacology: A nitric oxide link?. Biochem Pharmacol. 1997, 54 (1): 1-8. 10.1016/S0006-2952(97)00193-7.View ArticlePubMedGoogle Scholar
- Xie XS, Yang M, Liu HC, Zuo C, Li HJ, Fan JM: Ginsenoside Rg1, a major active component isolated from Panax notoginseng, restrains tubular epithelial to myofibroblast transition in vitro. J Ethnopharmacol. 2009, 122 (1): 35-41. 10.1016/j.jep.2008.11.020.View ArticlePubMedGoogle Scholar
- Zhang HG, Li XH, Yang ZC: Effects of Panax notoginseng saponins on myocardial Gsalpha mRNA expression and ATPase activity after severe scald in rats. Burns. 2003, 29 (6): 541-546. 10.1016/S0305-4179(03)00143-8.View ArticlePubMedGoogle Scholar
- Park WH, Lee SK, Kim CH: A Korean herbal medicine, Panax notoginseng, prevents liver fibrosis and hepatic microvascular dysfunction in rats. Life Sci. 2005, 76 (15): 1675-1690. 10.1016/j.lfs.2004.07.030.View ArticlePubMedGoogle Scholar
- Yang CY, Wang J, Zhao Y, Shen L, Jiang X, Xie ZG, Liang N, Zhang L, Chen ZH: Anti-diabetic effects of Panax notoginseng saponins and its major anti-hyperglycemic components. J Ethnopharmacol. 2010, 130 (2): 231-236. 10.1016/j.jep.2010.04.039.View ArticlePubMedGoogle Scholar
- Chen SW, Li XH, Ye KH, Jiang ZF, Ren XD: Total saponins of Panax notoginseng protected rabbit iliac artery against balloon endothelial denudation injury. Acta Pharmacol Sin. 2004, 25 (9): 1151-1156.PubMedGoogle Scholar
- Sengupta S, Toh SA, Sellers LA, Skepper JN, Koolwijk P, Leung HW, Yeung HW, Wong RN, Sasisekharan R, Fan TP: Modulating angiogenesis: The yin and the yang in ginseng. Circulation. 2004, 110 (10): 1219-1225. 10.1161/01.CIR.0000140676.88412.CF.View ArticlePubMedGoogle Scholar
- Lu MC, Lai TY, Hwang JM, Chen HT, Chang SH, Tsai FJ, Wang HL, Lin CC, Kuo WW, Huang CY: Proliferation-and migration-enhancing effects of ginseng and ginsenoside Rg1 through IGF-I- and FGF-2-signaling pathways on RSC96 Schwann cells. Cell Biochem Funct. 2009, 27 (4): 186-192. 10.1002/cbf.1554.View ArticlePubMedGoogle Scholar
- Ma ZC, Gao Y, Wang YG, Tan HL, Xiao CR, Wang SQ: Ginsenoside Rg1 inhibits proliferation of vascular smooth muscle cells stimulated by tumor necrosis factor-alpha. Acta Pharmacol Sin. 2006, 27 (8): 1000-1006. 10.1111/j.1745-7254.2006.00331.x.View ArticlePubMedGoogle Scholar
- Leung KW, Pon YL, Wong RN, Wong AS: Ginsenoside-Rg1 induces vascular endothelial growth factor expression through the glucocorticoid receptor-related phosphatidylinositol 3-kinase/Akt and beta-catenin/T-cell factor-dependent pathway in human endothelial cells. J Biol Chem. 2006, 281 (47): 36280-36288. 10.1074/jbc.M606698200.View ArticlePubMedGoogle Scholar
- Yin H, Liu Z, Li F, Ni M, Wang B, Qiao Y, Xu X, Zhang M, Zhang J, Lu H, Zhang Y: Ginsenoside-Rg1 enhances angiogenesis and ameliorates ventricular remodeling in a rat model of myocardial infarction. J Mol Med. 2011, 89 (4): 363-375. 10.1007/s00109-011-0723-9.View ArticlePubMedGoogle Scholar
- Kim YH, Lee YG, Choi KJ, Uchida K, Suzuki Y: Transglycosylation to ginseng saponins by cyclomaltodextrin glucanotransferases. Biosci Biotechnol Biochem. 2001, 65 (4): 875-883. 10.1271/bbb.65.875.View ArticlePubMedGoogle Scholar
- Rizzoni D, Porteri E, Boari GE, De Ciuceis C, Sleiman I, Muiesan ML, Castellano M, Miclini M, Agabiti-Rosei E: Prognostic significance of small-artery structure in hypertension. Circulation. 2003, 108 (18): 2230-2235. 10.1161/01.CIR.0000095031.51492.C5.View ArticlePubMedGoogle Scholar
- Mercier N, Labat C, Louis H, Cattan V, Benetos A, Safar ME, Lacolley P: Sodium, arterial stiffness, and cardiovascular mortality in hypertensive rats. Am J Hypertens. 2007, 20 (3): 319-325. 10.1016/j.amjhyper.2006.09.002.View ArticlePubMedGoogle Scholar
- Yu CM, Burrell LM, Black MJ, Wu LL, Dilley RJ, Cooper ME, Johnston CI: Salt induces myocardial and renal fibrosis in normotensive and hypertensive rats. Circulation. 1998, 98 (23): 2621-2628. 10.1161/01.CIR.98.23.2621.View ArticlePubMedGoogle Scholar
- Susic D, Frohlich ED, Kobori H, Shao W, Seth D, Navar LG: Salt-induced renal injury in SHRs is mediated by AT1 receptor activation. J Hypertens. 2011, 29 (4): 716-723. 10.1097/HJH.0b013e3283440683.View ArticlePubMedPubMed CentralGoogle Scholar
- Mimran A, du Cailar G: Dietary sodium: the dark horse amongst cardiovascular and renal risk factors. Nephrol Dial Transplant. 2008, 23 (7): 2138-2141. 10.1093/ndt/gfn160.View ArticlePubMedGoogle Scholar
- Leenen FH, Yuan B: Dietary-sodium-induced cardiac remodeling in spontaneously hypertensive rat versus Wistar-Kyoto rat. J Hypertens. 1998, 16 (6): 885-892. 10.1097/00004872-199816060-00020.View ArticlePubMedGoogle Scholar
- Vilela-Martin JF, Vaz-de-Melo RO, Kuniyoshi CH, Abdo AN, Yugar-Toledo JC: Hypertensive crisis: clinical-epidemiological profile. Hypertens Res. 2011, 34 (3): 367-371. 10.1038/hr.2010.245.View ArticlePubMedGoogle Scholar
- Ishimitsu T, Honda T, Ohno E, Furukata S, Sudo Y, Nakano N, Takahashi T, Ono H, Matsuoka H: Year-long antihypertensive therapy with candesartan completely prevents development of cardiovascular organ injuries in spontaneously hypertensive rats. Int Heart J. 2010, 51 (5): 359-364. 10.1536/ihj.51.359.View ArticlePubMedGoogle Scholar
- Hajdu MA, Baumbach GL: Mechanics of large and small cerebral arteries in chronic hypertension. Am J Physiol. 1994, 266 (3): H1027-H1033.PubMedGoogle Scholar
- Behbahani J, Thandapilly SJ, Louis XL, Huang Y, Shao Z, Kopilas MA, Wojciechowski P, Netticadan T, Anderson HD: Resveratrol and small artery compliance and remodeling in the spontaneously hypertensive rat. Am J Hypertens. 2010, 23 (12): 1273-1278. 10.1038/ajh.2010.161.View ArticlePubMedGoogle Scholar
- Intengan HD, Schiffrin EL: Vascular remodeling in hypertension: roles of apoptosis, inflammation, and fibrosis. Hypertension. 2001, 38 (3): 581-587. 10.1161/hy09t1.096249.View ArticlePubMedGoogle Scholar
- Feihl F, Liaudet L, Waeber B: The macrocirculation and microcirculation of hypertension. Curr Hypertens Rep. 2009, 11 (3): 182-189. 10.1007/s11906-009-0033-6.View ArticlePubMedGoogle Scholar
- Sonoyama K, Greenstein A, Price A, Khavandi K, Heagerty T: Vascular remodeling: implications for small artery function and target organ damage. Ther Adv Cardiovasc Dis. 2007, 1 (2): 129-137. 10.1177/1753944707086358.View ArticlePubMedGoogle Scholar
- Ferrario CM, Flack JM: Pathologic consequences of increased angiotensin II activity. Cardiovasc Drugs Ther. 1996, 10 (5): 511-518. 10.1007/BF00050990.View ArticlePubMedGoogle Scholar
- Schiffrin EL: Remodeling of resistance arteries in essential hypertension and effects of antihypertensive treatment. Am J Hypertens. 2004, 17 (12): 1192-1200. 10.1016/j.amjhyper.2004.05.023.View ArticlePubMedGoogle Scholar
- Kannel WB: Fifty years of framingham study contributions to understanding hypertension. J Hum Hypertens. 2000, 14 (2): 83-90. 10.1038/sj.jhh.1000949.View ArticlePubMedGoogle Scholar
- Bohle A, Muller GA, Wehrmann M, Mackensen-Haen S, Xiao JC: Pathogenesis of chronic renal failure in the primary glomerulopathies, renal vasculopathies, and chronic interstitial nephritides. Kidney Int Suppl. 1996, 54: S2-S9.PubMedGoogle Scholar
- Park JB, Schiffrin EL: Small artery remodeling is the most prevalent (earliest?) form of target organ damage in mild essential hypertension. J Hypertens. 2001, 19 (5): 921-930. 10.1097/00004872-200105000-00013.View ArticlePubMedGoogle Scholar
- Burlew BS, Weber KT: Cardiac fibrosis as a cause of diastolic dysfunction. Herz. 2002, 27 (2): 92-98. 10.1007/s00059-002-2354-y.View ArticlePubMedGoogle Scholar
- Brooks WW, Conrad CH, Robinson KG, Colucci WS, Bing OH: L-arginine fails to prevent ventricular remodeling and heart failure in the spontaneously hypertensive rat. Am J Hypertens. 2009, 22 (2): 228-234. 10.1038/ajh.2008.334.View ArticlePubMedGoogle Scholar
- Shen L, Han JZ, Li C, Yue SJ, Liu Y, Qin XQ, Liu HJ, Luo ZQ: Protective effect of ginsenoside Rg1 on glutamate-induced lung injury. Acta Pharmacol Sin. 2007, 28 (3): 392-397. 10.1111/j.1745-7254.2007.00511.x.View ArticlePubMedGoogle Scholar
- Najeeb UR, Mehmood MH, Alkharfy KM, Gilani AH: Prokinetic and laxative activities of lepidium sativum seed extract with species and tissue selective gut stimulatory actions. J Ethnopharmacol. 2011, 134 (3): 878-883. 10.1016/j.jep.2011.01.047.View ArticleGoogle Scholar
- Ghayur MN, Gilani AH: Species differences in the prokinetic effects of ginger. Int J Food Sci Nutr. 2006, 57 (1–2): 65-73.View ArticlePubMedGoogle Scholar
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6882/12/53/prepub
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