Molecular mechanisms underlying the role of nitric oxide in the cardiovascular system

In the cardiovascular system, nitric oxide (NO) is involved in the short and long-term regulation of haemodynamics, and in a number of their pathological alterations. Investigation into the biochemistry of NO-synthase isoforms has confirmed that they also all produce superoxide anion (O(*)). The free radical NO can interact with many targets on which novel information has been recently obtained. The major results of these interactions are not only the well known activation of guanylyl cyclase, but also the formation of potentially cytotoxic peroxynitrite (ONOO(-)), and the formation of S-nitrosothiols and non-haem iron-dinitrosyl dithiolate complexes. Tissue O(2), O(*), low molecular weight thiols and transition metals (especially FeII) play a pivotal role in directing NO towards targets responsible for biological effects, or storage or release from these stores. In addition, circulating forms of NO have been proposed with S-nitrosation of blood proteins. All these mechanisms provide potential pharmacological targets for future therapeutic strategies.     

Depression and cardiovascular disease: role of nitric oxide

Both depression and cardiovascular disease are major public health problems. Growing evidence shows that depression is a risk factor for the development of coronary artery disease (CAD). However, the exact mechanisms underlying the interplay between depression and CAD remain to be elucidated. Depression adversely affects autonomic and hormonal homeostasis, resulting in metabolic abnormalities, inflammation, increased platelet aggregation and endothelial dysfunction. All of these pathological features lead to atherothrombosis and cardiovascular events. However, there is no clear evidence that anti-depressant drugs or psychotherapy will reduce the risk or improve the outcome of CAD. Recent studies suggest that the L-arginine-nitric oxide (NO) pathway is involved in the genesis of depression. NO has many physiological functions, including vasodilatation, neurotransmission and platelet aggregation inhibition. It is synthesised from the cationic amino acid L-arginine by a family of enzymes: NO synthases (NOS). There are three NOS isoforms: inducible NOS (iNOS), endothelial NOS and neuronal NOS (nNOS). The availability and transport of L-arginine modulate rates of NO biosynthesis in circulating blood cells and vasculature, which provides a protective effect against cardiovascular disease. In depressive patients, the L-arginine-nitric oxide pathway seems to be impaired. The present review seeks a better understanding of the mechanisms that could identify depression as a cardiovascular risk factor and introduce new possible therapeutic interventions.     

硫化氢在心血管系统中的作用

<正>随着科技的发展,人们认识到硫化氢(Hydrogen sulfide, H2S)是继一氧化氮(Nitric oxide,NO)和的一氧化碳(Carbon monoxide,CO)后发现的第三个内源性气体信使(Endothelia gasotransmitter),目前对作为气体信号分子系统的新成员—H2S的生物学效应报道较少,已有实验证实H2S在循环系统、神经系统、消化系统、泌尿系统均有重要生理效应。本文着重讨论H2S在心血管系统中的生理作用和在发病机制中的作用。     

The role of nitric oxide on endothelial function

The vascular endothelium is a monolayer of cells between the vessel lumen and the vascular smooth muscle cells. Nitric oxide (NO) is a soluble gas continuously synthesized from the amino acid L-arginine in endothelial cells by the constitutive calcium-calmodulin-dependent enzyme nitric oxide synthase (NOS). This substance has a wide range of biological properties that maintain vascular homeostasis, including modulation of vascular dilator tone, regulation of local cell growth, and protection of the vessel from injurious consequences of platelets and cells circulating in blood, playing in this way a crucial role in the normal endothelial function. A growing list of conditions, including those commonly associated as risk factors for atherosclerosis such as hypertension, hypercholesterolemia, smoking, diabetes mellitus and heart failure are associated with diminished release of nitric oxide into the arterial wall either because of impaired synthesis or excessive oxidative degradation. The decreased production of NO in these pathological states causes serious problems in endothelial equilibrium and that is the reason why numerous therapies have been investigated to assess the possibility of reversing endothelial dysfunction by enhancing the release of nitric oxide from the endothelium. In the present review we will discuss the important role of nitric oxide in physiological endothelium and we will pinpoint the significance of this molecule in pathological states altering the endothelial function.     

Direct inhibition of endothelial nitric oxide synthase by hydrogen sulfide: contribution to dual modulation of vascular tension

We characterized actions of hydrogen sulfide (H(2)S) on tension of isolated rat and mouse aortae, and then examined if H(2)S could directly modulate activity of endothelial nitric oxide (NO) synthase (eNOS). Isometric tension was recorded in rat and mouse aortic rings. Activity of recombinant bovine eNOS was determined as conversion of [(3)H]-arginine into [(3)H]-citrulline. NaHS, a H(2)S donor, caused contraction at low concentrations and relaxation at high concentrations in both rat and mouse aortae precontracted with phenylephrine. The contractile and relaxant effects of NaHS were enhanced and partially blocked, respectively, by the K(+)(ATP) channel inhibitor glibenclamide in the rat, but not mouse, aortae. In the KCl-precontracted rat aorta, NaHS produced glibenclamide-resistant contraction and relaxation. NaHS produced only relaxation, but not contraction, in the endothelium-denuded aortae, and also in the endothelium-intact aortae in the presence of inhibitors of NOS or soluble guanylate cyclase. NaHS pretreatment greatly attenuated the relaxation induced by acetylcholine, but not by an NO donor, in the tissues. Finally, we found that NaHS inhibited the conversion of [(3)H]-arginine into [(3)H]-citrulline by recombinant eNOS. NaHS thus causes contraction and relaxation in rat and mouse aortae. K(+)(ATP) channels are considered to contribute only partially to the NaHS-evoked relaxation. Most interestingly, our data demonstrate direct inhibition of eNOS by NaHS, probably responsible for its contractile activity, being evidence for a novel function of H(2)S.     

Emerging role of hydrogen sulfide in hypertension and related cardiovascular diseases

Hydrogen sulfide (H₂S) has traditionally been viewed as a highly toxic gas; however, recent studies have implicated H₂S as a third member of the gasotransmitter family, exhibiting properties similar to NO and carbon monoxide. Accumulating evidence has suggested that H₂S influences a wide range of physiological and pathological processes, among which blood vessel relaxation, cardioprotection and atherosclerosis have been particularly studied. In the cardiovascular system, H₂S production is predominantly catalyzed by cystathionine γ‐lyase (CSE). Decreased endogenous H₂S levels have been found in hypertensive patients and animals, and CSE ^−/− mice develop hypertension with age, suggesting that a deficiency in H₂S contributes importantly to BP regulation. H₂S supplementation attenuates hypertension in different hypertensive animal models. The mechanism by which H₂S was originally proposed to attenuate hypertension was by virtue of its action on vascular tone, which may be related to effects on different ion channels. Both H₂S and NO cause vasodilatation and there is cross‐talk between these two molecules to regulate BP. Suppression of oxidative stress may also contribute to antihypertensive effects of H₂S. This review also summarizes the state of research on H₂S and hypertension in China. A better understanding of the role of H₂S in hypertension and related cardiovascular diseases will allow novel strategies to be devised for their treatment.

Linked Articles

This article is part of a themed section on Chinese Innovation in Cardiovascular Drug Discovery. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2015.172.issue-23

Abbreviation

2K1C

two‐kidney‐one‐clip

Ang II

angiotensin II

AOA

aminooxyacetic acid

AT₁ receptor

angiotensin II type 1 receptor

CBS

cystathionine‐β‐synthase

CO

carbon monoxide

CSE

cystathionine‐γ‐lyase

DBP

diastolic BP

eNOS

endothelial NOS

H₂S

hydrogen sulfide

I/R

ischaemia/reperfusion

L‐NAME

N^G‐nitro‐l‐arginine methyl ester

MAP

mean arterial pressure

MPST

3‐mercaptopyruvate sulfurtransferase

MWT

medial wall thickness

PAAT

pulmonary arterial acceleration time

PAG

DL‐propargylglycine

PHT

pulmonary hypertension

RVET

right ventricular ejection time

RVH

right ventricular hypertrophy

SBP

systolic BP

SHR

spontaneously hypertensive rat

SMCs

smooth muscle cells

VEGFR‐1

soluble fms‐like tyrosine kinase 1

VD

vas deferens

Tables of Links

Analysis of agonist-evoked nitric oxide release from human endothelial cells: role of superoxide anion

1. Dichlorofluorescein oxidation and electrochemical monitoring of in situ nitric oxide (NO) release from cultured human endothelial cells reveals that agonists such as thrombin and histamine simultaneously stimulate transient superoxide production. 2. The duration of *NO release was increased only in the simultaneous presence of extracellular L-arginine and exogenous superoxide dismutase. In contrast, the inhibition of membrane reduced nicotinamide adenine dinucleotide (phosphate) oxidases, the major source of *O2- in endothelial cells, did not prolong *NO release, although extracellular L-arginine was also present. Comparison of these two experimental conditions suggested that H2O2 was involved in the extension of the *NO signal. 3. The present study demonstrates that, in the absence of external L-arginine, *O2- production does not constitute the major pathway controlling the duration of agonist-induced *NO signal. These results suggest that L-arginine and H2O2 act jointly to maintain nitric oxide synthase in an activated form.     

气体信号一氧化氮与硫化氢在肺动脉舒张反应中的相互作用

目的　探讨气体信号一氧化氮与硫化氢在正常大鼠离体肺动脉舒张反应中的相互作用。方法　正常♂SD大鼠 7只 ,体重 2 5 0～ 2 6 0g ,麻醉后迅速取肺动脉环离体灌注 ,观察它对不同浓度一氧化氮供体硝普钠、硫化氢供体硫氢化钠的舒张反应 ;分别给予血管环DL propargylglycine (PPG)和Nω 硝基 L 精氨酸甲酯 (L NAME) ,观察它们对硝普钠、硫氢化钠舒张反应的影响。结果　肺动脉对不同浓度硝普钠、硫化氢呈现剂量依赖性舒张反应 ,PPG可减弱硝普钠对血管环的舒张作用 ,而L NAME可减弱硫化氢对血管环的舒张作用。结论　硫化氢可以独立及与一氧化氮协同发挥舒张血管效应 ,硝普钠可以独立及与硫化氢协同发挥舒张血管效应 ,气体信号分子网络在肺血管舒张反应的机制中占据重要地位。     

Quinacrine increases endothelial nitric oxide release: role of superoxide anion

The effect of acute quinacrine treatment on agonist-induced nitric oxide (NO) release was investigated in cultured human endothelial cells using electrochemical monitoring of the in situ NO concentration. Quinacrine dose-dependently increased NO release with an apparent EC50 of 0.2 microM and a maximal effect at 1 microM. Quinacrine did not modify the dependence of NO release on extracellular L-arginine. Acceleration or deceleration of O2- dismutation, which altered NO release in control cells, did not modify it in quinacrine-treated cells. Quinacrine did not modify NO amperometric signal or reaction with O2- produced by xanthine oxidation. In the presence of quinacrine, agonist-induced NO release became Mg2+ -independent and could not be attributed to an inhibition of phospholipase A2 activity. Quinacrine made NO release insensitive to Cu2+ chelation. The present study demonstrates that acute treatment by low quinacrine concentrations increases endothelial NO release, possibly through an inhibition of O2- production.     

Normal and pathological distribution of nitric oxide in the cardiovascular system.

Using microsensors, it is possible to quantify the amount and concentration of nitric oxide (NO) release throughout the cardiovascular system in veins, arteries and the heart. Under normal physiological conditions a well defined distribution of NO is maintained. This concentration depends++ on the laminar, turbulent, or pulsatile flow rate of blood. Significantly reduced production of NO is observed in the pathogenesis of cardiovascular disorders like hypertension, atherosclerosis and diabetes. This is due to increased generation of superoxide by a dysfunctional endothelium and the rapid formation of peroxynitrite followed by formation of peroxynitrite followed by the formation of highly reactive OH and NO2 radicals and NO2+. Elevated concentration or improved mass transport of L-arginine and (6)-5,6,7,8-tetrahydrobiopterin can be applied to increase/decrease NO/superoxide release by the dysfunctional endothelium.     

普伐他汀对人内皮祖细胞一氧化氮合成的影响

目的观察普伐他汀对人内皮祖细胞（EPCs）一氧化氮（NO）合成的影响。方法密度梯度离心法获取外周血单个核细胞,培养7d后,收集贴壁细胞并分别加入普伐他汀,10μmol/L及100μmol/L干预48h,免疫组化、荧光显微镜和流式细胞仪鉴定EPC,用RT-PCR方法测定对细胞内皮型一氧化氮合酶（eNOS）mRNA表达的影响,并用硝酸还原酶法测定培养液中一氧化氮（NO）的水平。结果普伐他汀组的人内皮祖细胞eNOS mRNA的表达、NO的合成明显增加。结论普伐他汀可增加人内皮祖细胞eNOS mRNA的表达和NO的合成     

Increase in exhaled nitric oxide and protective role of the nitric oxide system in experimental pulmonary embolism

BACKGROUND AND PURPOSE: Pulmonary embolism (PE) represents a real diagnostic challenge. PE is associated with pulmonary hypertension due to pulmonary vascular obstruction and vasoconstriction. We recently reported that pulmonary gas embolism transiently increases exhaled nitric oxide (FENO), but it is not known whether solid emboli may alter FENO, and whether an intact endogenous NO synthesis has a beneficial effect in experimental solid pulmonary embolism. EXPERIMENTAL APPROACH: We used anaesthetised and ventilated rabbits in these experiments. To mimic PE, a single intravenous infusion of homogenized autologous skeletal muscle tissue (MPE) was given to rabbits with intact NO production (MPE of 60, 15, or 7.5 mg kg(-1); group 1) and to another group (group 2) with inhibited NO synthesis (L-NAME 30 mg kg(-1); MPE of 7.5, 15 or 30 mg kg(-1)). KEY RESULTS: In group 1, after MPE, FENO increased rapidly and dose-dependently and FENO was still significantly elevated after 60 min with the two highest emboli doses. All these animals survived more than 60 min after embolization. In group 2, MPE of 7.5, 15 and 30 mg kg(-1), in combination with NO synthesis inhibition, resulted in 67%, 50% and 25% survival at 60 min respectively, representing a statistically significant decrease in survival. Cardiovascular and blood-gas changes after MPE were intensified by pre-treatment with NO synthesis inhibitor. CONCLUSIONS AND IMPLICATIONS: We conclude that solid PE causes a sustained, dose-dependent increase in FENO, giving FENO a diagnostic potential in PE. Furthermore, intact NO production appears critical for tolerance to acute PE.     

Baicalin-induced vascular response in rat mesenteric artery: role of endothelial nitric oxide

1. Baicalin was isolated and purified from the dry roots of Scutellaria baicalensis Georgi (Huangqin; a traditionally used Chinese medicinal herb) and its effect on the contractility of rat isolated mesenteric arteries was investigated and the role of the endothelium was examined. 2. The concentration-dependent contractile response to U46619 was enhanced by 10(-5) mol/L baicalin in endothelium-intact rings, but this effect was abolished in the presence of 10(-4) mol/L N(G)-nitro-L-arginine or in endothelium-denuded rings. 3. Pretreatment of endothelium-intact rings with baicalin (3 x 10(-5) mol/L) markedly attenuated the relaxant response to A23187, thapsigargin and acetylcholine. 4. The present results indicate an important role for endothelial nitric oxide (NO) in the vascular response to baicalin. Baicalin appears to inhibit NO production and release in the endothelium and this mechanism is likely to be responsible for the enhancement of the U46619-induced contraction and for inhibition of endothelial NO-mediated relaxation by baicalin in rat mesenteric artery.     

Regional differences in the arterial response to vasopressin: role of endothelial nitric oxide.

1. The isometric response to arginine-vasopressin (10(-10)-10(-7)M) was studied in 2 mm long rabbit arterial segments isolated from several vascular beds (cutaneous, pial, renal, coronary, muscular, mesenteric and pulmonary). 2. Vasopressin induced contraction in central ear (cutaneous), basilar (pial), renal, coronary and saphenous (muscular) arteries, but had no effect in mesenteric and pulmonary arteries; the order of potency for the contraction was: ear > basilar > renal > coronary > saphenous arteries. 3. Treatment with the blocker of nitric oxide synthesis NG-nitro-L-arginine methyl ester (L-NAME; 10(-6)-10(-4) M) increased significantly (P < 0.05) the contraction to vasopressin in ear (148% of control), basilar (150% of control), renal (304% of control), coronary (437% of control) and saphenous (235% of control) arteries. Removal of the endothelium increased significantly (P < 0.05) the contraction to vasopressin in basilar (138% of control), renal (253% of control), coronary (637% of control) and saphenous (662% of control) arteries, but not in ear artery. Mesenteric and pulmonary arteries in the presence of L-NAME or after endothelium removal did not respond to vasopressin, as occurred in control conditions. 4. The specific antagonist for V1 vasopressin receptors d(CH2)5Tyr(Me)AVP (3 x 10(-9)-10(-7) M) was more potent (pA2 = 9.3-10.1) than the antagonist for both V1 and V2 vasopressin receptors desGly-d(CH2)5-D-Tyr(Et)ValAVP (10(-7)-10(-6) M) (pA2 = 7.4-8.4) to block the contraction to vasopressin of ear, basilar, renal and coronary arteries. 5. The specific V2 vasopressin agonist [deamino-Cys1, D-Arg8]-vasopressin (desmopressin) (10(-10)-10(-7) M) did not produce any effect in any effect in any of the arteries studied, with or without endothelium. 6. In arteries precontracted with endothelin-1, vasopressin or desmopressin did not produce relaxation. 7. These results suggest: (a) most arterial beds studied (5 of 7) exhibit contraction to vasopressin with different intensity; (b) the vasoconstriction to this peptide is mediated mainly by stimulation of V1 vasopressin receptors, and (c) endothelial nitric oxide may inhibit the vasoconstriction to this peptide, especially in coronary and renal vasculatures.     

Effects of angiotensin receptor blockers on endothelial nitric oxide release: the role of eNOS variants

AIM

Angiotensin II receptor blockers (ARBs) improve endothelial cell (EC)-dependent vasodilation in patients with hypertension through suppression of angiotensin II type 1 receptors but may have additional and differential effects on endothelial nitric oxide (NO) synthase (eNOS) function. To investigate this question, we tested the effects of various ARBs on NO release in ECs from multiple donors, including those with eNOS genetic variants linked to higher cardiovascular risk.

METHODS

The effects of ARBs (losartan, olmesartan, telmisartan, valsartan), at 1 µm, on NO release were measured with nanosensors in human umbilical vein ECs obtained from 18 donors. NO release was stimulated with calcium ionophore (1 µm) and its maximal concentration was correlated with eNOS variants. The eNOS variants were determined by a single nucleotide polymorphism in the promoter region (T-786C) and in the exon 7 (G894T), linked to changes in NO metabolism.

RESULTS

All of the ARBs caused an increase in NO release as compared with untreated samples (P < 0.01, n = 4–5 in all eNOS variants). However, maximal NO production was differentially influenced by eNOS genotype. Olmesartan increased maximal NO release by 30%, which was significantly greater (P < 0.01, n = 4–5 in all eNOS variants) than increases observed with other ARBs.

CONCLUSIONS

The ARBs differentially enhanced NO release in ECs in a manner influenced by eNOS single nucleotide polymorphisms. These findings provide new insights into the effects of ARBs on EC-dependent vasodilation and eNOS function.     

Cicletanine stimulates nitric oxide release and scavenges superoxide in endothelial cells

Cicletanine ((+/-)3-(4-chlorophenyl)-1,3-dihydro-7-hydroxy-6-methylfuro-[3,4-c] pyridine) 3-(4-chlorophenyl)-1,3-dihydro-7-hydroxy-6-methylfuro-[3,4-c] pyridine) is a novel antihypertensive vasodilator with an incompletely understood mechanism of action. In the studies described here, the release of nitric oxide and superoxide (O2-) stimulated by cicletanine was measured simultaneously in the endothelium of isolated rat aortic rings. Highly sensitive electrochemical nitric oxide and O2- microsensors were placed near the surface of endothelial cells and the kinetics of nitric oxide and O2- release were monitored in situ. The response times for nitric oxide and O2- microsensors were 100 micros and 50 micros, respectively, and detection limit was 10(-9) M. Cicletanine stimulated nitric oxide release in aorta endothelium at (micromolar) therapeutic concentrations that were consistent with the concentrations of the compound to induce endothelium-dependent vasorelaxation in isolated rat aorta. The peak concentration of nitric oxide was 160+/-8 nM. This concentration was about 70% and was 60% lower as compared with the nitric oxide peak concentration observed after stimulation with receptor-independent agonist (calcium ionophore A23187) and receptor-dependent agonist (acetylcholine), respectively. However, after administration of cicletanine, only a small concentration of O2- was recorded (peak 3.1+/-0.2 nM) contrary to a large concentration (27+/-1.35 nM) observed after stimulation with A23187). Cicletanine not only stimulated nitric oxide release but also was a potent scavenger of O2- at nanomolar level. Both of these effects may contribute to potent vasorelaxation properties of cicletanine and its long-term therapeutic actions, resulting in cardiovascular tissue protection.     

Gene transfer of vascular endothelial growth factor and endothelial nitric oxide synthase--implications for gene therapy in cardiovascular diseases

Gene therapy is based on the delivery of exogenous genetic material in order to influence the endogenous genetic components involved in disease development. This new therapeutic approach has been suggested to have great potential in the treatment of insufficient angiogenesis or in prevention of restenosis after balloon angioplasty of atherosclerotic arteries. As both vascular endothelial growth factor (VEGF) and nitric oxide (NO) exert beneficial effects on vascular physiology, we studied the generation of both compounds after in vitro transfection of relevant genes. The plasmid vectors, containing VEGF cDNA were constructed and lipotransfected into vascular smooth muscle cells (VSMC). Transfected cells generated up to a few nanograms of VEGF, which induced proliferation of endothelial cells. VSMC transfected with another plasmid, containing endothelial constitutive NO synthase (ecNOS) cDNA generated micromolar quantities of nitrite. Moreover, such NO-producing cells synthesized significantly more VEGF than VSMC transfected with control plasmids. Thus, the study demonstrated that transfer of VEGF and/or NOS genes to VSMC led to the production of measurable amounts of both VEGF protein and NO. Additionally, we evidenced that NO can enhance the endogenous generation of VEGF. A new protective mechanism of NO has been thus revealed.     

Effect of methylguanidine on rat blood pressure: role of endothelial nitric oxide synthase.

1. The effect of acute i.v. administration of methylguanidine (MG) on mean arterial blood pressure (MABP) was investigated in anaesthetized male Wistar rats. 2. MG (1-30 mg kg-1 i.v.) produced an increase in MABP in a dose-dependent manner both in normal and in hexamethonium (5 mg kg-1, i.v)-treated rats. 3. L-Arginine (30 or 150 mg kg-1, i.v.), but not its enantiomer D-arginine (30 or 150 mg kg-1, i.v.), reversed the effect of MG on MABP in both normal and hexamethonium-treated rats. 4. L-Arginine (150 mg kg-1, i.v.) administered 2 min before MG (30 mg kg-1, i.v.) prevented the increase in MABP caused by MG in either normal or hexamethonium-treated rats. This effect was not observed with D-arginine (150 mg kg-1, i.v.). 5. Thus, the rise in MABP caused by MG in the anaesthetized rat is due to inhibition of endothelial NO-synthase activity. We speculate that the rise in the plasma concentration of endogenous MG associated with uraemia may contribute to the hypertension seen in patients with chronic renal failure.     

Effect of cicletanine on the nitric oxide pathway in human umbilical vein endothelial cells

The purpose of this study was to evaluate the effects of cicletanine, a slightly diuretic antihypertensive drug, on human vascular endothelial cells with regard to nitric oxide, intracellular calcium concentration ([Ca2+]i), cyclic nucleotide, inositol 1,4,5-trisphosphate (IP3), and prostacyclin generation. Primary cultured human umbilical vein endothelial cells were used in this study. [Ca2+]i was measured by fura-2/AM. Cyclic adenosine monophosphate (AMP), cyclic guanosine monophosphate (GMP), IP3, and prostacyclin were measured by radioimmunoassay. Nitric oxide was measured by the Griess method. Cicletanine had no effect on [Ca2+]i. Cicletanine (10(-6)-10(-4) M) increased cyclic GMP but decreased prostacyclin generation. Cicletanine had no stimulating effect on cyclic AMP or IP3 generation. IP3 increased 45Ca release from storage sites. Cicletanine decreased prostacyclin generation via increase in cyclic GMP. Cicletanine had no stimulating effect on nitrogen oxides for 2 h after incubation but increased it after 3-24 h. Pretreatment with L-N(G)-monomethyl-arginine (L-NMMA) prevented this increase. The inhibitory effect of L-NMMA was prevented by pretreatment with L-arginine. These results indicate that nitric oxide and cyclic GMP may contribute to the antihypertensive action of cicletanine.