Endothelial function and the control of vascular tone
Nitric oxide, prostacyclin and endothelin as the endothelium's controls on vascular tone, the cGMP pathway that nitrates, PDE5 inhibitors and riociguat act on, the endothelium's antithrombotic surface, and what endothelial dysfunction means in atherosclerosis, sepsis and pre-eclampsia.
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- The endothelium releases vasodilators (nitric oxide, prostacyclin, endothelium-derived hyperpolarising factor) and vasoconstrictors (endothelin-1, thromboxane, angiotensin II via surface ACE).
- NO → soluble guanylate cyclase → cGMP → PKG → relaxation. Nitrates, PDE5 inhibitors and riociguat all act on this pathway.
- A healthy endothelium is antithrombotic, anti-inflammatory and anti-proliferative. Endothelial dysfunction, mostly loss of NO bioavailability, is the first step in atherosclerosis.
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Sources
- Beltrame JF, Crea F, Kaski JC et al. International standardization of diagnostic criteria for vasospastic angina (COVADIS). Eur Heart J 2017;38:2565-8European Heart Journal, 2017
- Adempas (riociguat) prescribing information: boxed warning and contraindicationsDailyMed, US National Library of Medicine (Bayer), accessed 2026-11-13
- ProvayBlue (methylene blue) prescribing information: serotonin syndrome boxed warning, G6PD contraindicationDailyMed, US National Library of Medicine, accessed 2026-11-13
- Braunwald's Heart Disease, 12th editionElsevier (Libby P, Bonow RO, Mann DL et al.), 2022
- Guyton and Hall Textbook of Medical Physiology, 14th editionElsevier (Hall JE, Hall ME), 2021
- Furchgott RF, Zawadzki JV. The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine. Nature 1980;288:373-6Nature, 1980
- Zeisler H, Llurba E, Chantraine F et al. Predictive value of the sFlt-1:PlGF ratio in women with suspected preeclampsia. N Engl J Med 2016;374:13-22New England Journal of Medicine, 2016
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- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy