PPARs: the vasculature, inflammation and hypertension

PURPOSE OF REVIEW: Peroxisome proliferator-activated receptors (PPARs) are a family of nuclear receptors activated by nutrient molecules and their derivatives. Their role has been increasingly recognized to be important in hypertension, metabolic disorders and cardiovascular disease, including atherosclerosis. Control of innate inflammatory processes mostly through alteration of monocyte/macrophage phenotype promises to be a unifying paradigm in understanding the pleiotropic effects of PPAR agonists. RECENT FINDINGS: Although PPAR-gamma was the first to be described as an anti-inflammatory agent, both PPAR-alpha and PPAR-delta are now known to have similar effects as well. Inflammation is an important part of the damage caused by hypertensive diseases. PPARs have now been recognized as important determinants of macrophage polarization. Monocyte precursors of classical and alternatively activated macrophages are being defined as important changes in progression of cardiovascular disease associated with metabolic syndrome including hypertension, hyperlipidemia and obesity. SUMMARY: A major unifying role for PPARs in hypertension and its complications through modification of the innate immune system and inflammation is increasingly likely. PPAR agonists may be beneficial, alone or in combination with other drugs that modify the inflammatory response, in treating hypertension, atherosclerosis and metabolic derangements associated with obesity.