The prevalence of hypertension is increasing globally, while strategies for prevention and treatment of hypertension remain limited. FG-4592 (Roxadustat) is a novel, orally active small-molecule HIF stabilizer, and is being used clinically to treat CKD anemia. In the present study, we evaluate the effects of FG-4592 on hypertension. In an Ang II hypertension model, FG-4592 abolished hypertensive responses, prevented vascular thickening, cardiac hypertrophy, and kidney injury, downregulated AGTR1 expression, and enhanced AGTR2, eNOS, and HIF1α protein levels in the aortas of mice. Additionally, the levels of thiobarbituric acid reactive substances (TBARs) in blood and urine were diminished by FG-4592 treatment. In vascular smooth muscle cells, FG-4592 treatment reduced AGTR1 and increased AGTR2 levels, while preventing Ang II-induced oxidative stress. In vascular endothelial cells, FG-4592 upregulated total and phosphorylated eNOS. Moreover, FG-4592 treatment was hypotensive in L-NAME-induced hypertension. In summary, FG-4592 treatment remarkably ameliorated hypertension and organ injury, possibly through stabilizing HIF1α and subsequently targeting eNOS, AGTR1, AGTR2, and oxidative stress. Therefore, in addition to its role in treating CKD anemia, FG-4592 could be explored as a treatment for hypertension associated with high RAS activity or eNOS defects.

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