To investigate the bioactive components of Sangqi Qingxuan formula (SQQX), predict the pharmacological targets, and explore the mechanism of hypertensive vascular remodeling (HVR).

Network pharmacology was adopted to predict how SQQX acts in HVR. The effectiveness was assessed by blood pressure measurements and pathological morphology observation based on a spontaneously hypertensive rat model, while the mechanism of SQQX on HVR was validated by immunohistochemistry (IHC) and western blot (WB) according to the results of network pharmacology.

There were 130 bioactive components of SQQX and 231 drug targets predicted by the Traditional Chinese Medicine Systems Pharmacology Database. Subsequently, 181 common targets were identified for SQQX against HVR, with TP53, MAPK1, and AKT1 as the core targets. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses was employed to identify the top 20 enriched functions and the top 20 pathways (P < .01). Finally, the key role of the ERK/MAPK signaling pathway in HVR was determined. The in vivo results suggested that SQQX reduced systolic blood pressure and increased the ratio of thoracic aortic wall thickness to lumen diameter. Additionally, compared with the model group, SQQX increased the expression of smooth muscle 22 alpha (IHC: P < .001; WB: P < .05) and decreased the expression of osteopontin (IHC: P < .001; WB: P < .05), ERK1/2 (IHC: P < .001; WB: ERK1 & ERK2, all P < .05), p-ERK1/2 (IHC: P < .001; WB: ERK1 & ERK2, all P < .05), and the ratio of p-ERK1/2 to ERK1/2 protein (IHC: P < .001).

SQQX, which has multiple bioactive ingredients and potential targets, is an effective treatment for HVR. The mechanism of antihypertensive and vascular protection may be related to the inhibition of phenotypic transformation of vascular smooth muscle cells and the ERK/MAPK signaling pathway.