You have probably heard of blood pressure, how it can be a sign or marker of your health. However, how to define or understand what we mean when we talk about blood pressure is somewhat more complex.
As we already know, blood is essentially composed of plasma and cells; it circulates through blood vessels, those “pipes” that transport liquid to all organs and tissues. There are different types of blood vessels: veins and arteries. The arteries transport oxygenated blood, pumped by the heart so that it reaches the rest of the organs and tissues. The veins are responsible for collecting the blood already used from the organs and returning it back to the cardiorespiratory system so that it can be oxygenated and redistributed (1).
Now that we know this, we will define blood pressure as the force that blood exerts when pushing against the walls of the arteries. As has been said before, the heart is responsible for pumping blood, and when this occurs, blood pressure is higher. This high blood pressure is a systolic blood pressure, since it is directly related to pumping contraction or systole. On the other hand, when the heart relaxes, blood pressure is low, giving rise to diastolic blood pressure. This low blood pressure is what we can measure between beats, when the heart relaxes and performs what is known as diastole (2 and 3).
Normal BP values.
Once we have learned what blood pressure is and seen that we will always obtain two values, high and low pressure, we must know what values are considered normal. Generally, the normal high or systolic value is less than 120 mm Hg (millimeters of mercury). Normal low or diastolic pressure values are less than 80 mm Hg. These values could be altered by increasing pressure, which in most cases does not produce symptoms and may go unnoticed. However, it can be harmful to health to maintain high blood pressure over time, as the heart pumps harder and works excessively. High blood pressure (hypertension) can damage the heart, blood vessels, and kidneys. Blood pressure increases when blood vessels constrict (vasoconstriction), but usually decreases when they dilate (vasodilation). Whatever happens depends on many factors such as stress, temperature or some substances consumed (3).
How can CBD affect blood pressure?
As we already know, cannabidiol (CBD) is a phytocannabinoid without psychoactive effects that has suggested some evidence in the improvement of pathologies such as diabetes, inflammatory diseases or neurodegenerative disorders. It has been shown to be very safe and well tolerated at high doses in clinical trials, something that has made it a therapeutic ally. On the other hand, we have thought about evaluating its effects at the vascular level, since other cannabinoids such as THC or anandamide have shown a vasodilatory effect in in vitro and in vivo models. (4 and 5)
Studies related to its possible vascular effects have focused on a synthetic analogue, Abn-CBD or abnormal CBD. Although the exact route by which it acts is not known, it has demonstrated vasodilation and hypotensive effect in mice. In this same study, it was discovered that CBD antagonizes the vasodilatory effect of its synthetic analogue, suggesting that they compete for the same receptors (5).
In other studies focused on CBD, it was seen that at low concentrations it does not produce any effect on blood vessels. When higher doses were used, vasodilation did occur, which suggests that this effect is dose-dependent. Furthermore, it has been seen that the cannabinoid receptor involved in this effect is CB1, which would cause the release of nitric oxide. Nitric oxide is an endogenous substance that directly intervenes in the relaxation process of smooth muscles, which facilitates the dilation of blood vessels.
In addition to this, CBD has been shown to be a partial agonist of the PPAR receptor, this means that it binds weakly to this receptor and produces certain effects. These effects include increasing the activity of an enzyme called superoxide dismutase, which, in addition to being a powerful antioxidant, also facilitates vasodilation. Due to all this explained pharmacological activity, CBD could lower blood pressure (5).
What are the cardiovascular effects of CBD?
After seeing this evidence, it would not be strange to think that these effects could play a key role in other cardiovascular pathologies. It has been seen that CBD could have cardioprotective effects, which include damage associated with cardiac ischemia, as well as the liver and brain. Ischemia is the reduction of blood flow in the affected tissues, which causes a decrease in the amount of oxygen and nutrients in the affected tissue. When ischemia occurs in the arteries that supply the brain, a stroke or cerebral infarction could occur, and if this occurs in the coronary arteries, a heart attack (myocardium) could occur. However, these cardioprotective effects are due to a mechanism of action different from that explained above. CBD has been shown to be a great immunomodulator, which means that it orchestrates the immune system so that it does not produce an exaggerated inflammatory reaction and aggravate the heart attack. The direct mechanism of action involved in this would be the decrease in oxidative stress, the concentration of interleukin (IL)-6 and tumor necrosis factor, among others. These last two are mediators of inflammation that increase and accentuate the immune response. In addition to these effects, it has been shown to improve arrhythmia, by reducing irregular heartbeats (5 and 6).
Other scientific evidence suggests that CBD could have a protective role against atherosclerosis in diabetics. Atherosclerosis occurs when blood vessels thicken and harden, sometimes-restricting blood flow to organs and tissues. Healthy arteries are flexible and elastic, but over time, the walls of the arteries can harden, a condition commonly called arterial hardening. In an environment in which blood glucose is elevated, dysfunction in the endothelium is promoted.
The endothelium can be defined as a monolayer that separates tissues from blood. The main function of the endothelium is to regulate blood flow and perfusion through changes in vascular diameter and tone. Endothelial dysfunction comprises a loss of balance between vasodilator and vasoconstrictor factors derived from the endothelium, where the vasoconstrictor state becomes dominant, leading to progressive pathophysiological changes. All of these changes could lead to the formation of atherosclerosis, especially in diabetics. CBD has been shown to improve endothelial dysfunction in diabetes by reducing certain adhesion molecules (ICAM-1 and VCAM-1), alteration of the skin barrier and mitochondrial superoxide (5, 6 and 7).
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