Coronary Microvascular Dysfunction and Hypertension: A Bond More Important than We Think

Abstract

Coronary microvascular dysfunction (CMD) is a clinical entity linked with various risk factors that significantly affect cardiac morbidity and mortality. Hypertension, one of the most important, causes both functional and structural alterations in the microvasculature, promoting the occurrence and progression of microvascular angina. Endothelial dysfunction and capillary rarefaction play the most significant role in the development of CMD among patients with hypertension. CMD is also related to several hypertension-induced morphological and functional changes in the myocardium in the subclinical and early clinical stages, including left ventricular hypertrophy, interstitial myocardial fibrosis, and diastolic dysfunction. This indicates the fact that CMD, especially if associated with hypertension, is a subclinical marker of end-organ damage and heart failure, particularly that with preserved ejection fraction. This is why it is important to search for microvascular angina in every patient with hypertension and chest pain not associated with obstructive coronary artery disease. Several highly sensitive and specific non-invasive and invasive diagnostic modalities have been developed to evaluate the presence and severity of CMD and also to investigate and guide the treatment of additional complications that can affect further prognosis. This comprehensive review provides insight into the main pathophysiological mechanisms of CMD in hypertensive patients, offering an integrated diagnostic approach as well as an overview of currently available therapeutical modalities.

Interplay between Senescence and Macrophages in Diabetic Cardiomyopathy: A Review of the Potential Role of GDF-15 and Klotho

“…Microvascular remodeling includes the thickening of the arteriole wall, the narrowing of the lumen, fibrosis, and capillary rarefaction. Similarly, hypertension is another risk factor that leads to coronary microvascular alterations and promotes the progression of endothelial dysfunction and capillary rarefaction [29]. Hypertension-induced changes in myocardial morphology and function also contribute to left ventricular hypertrophy and myocardial fibrosis [29]; indeed, hypertension and type 2 diabetes are common comorbidities.…”

“…Similarly, hypertension is another risk factor that leads to coronary microvascular alterations and promotes the progression of endothelial dysfunction and capillary rarefaction [29]. Hypertension-induced changes in myocardial morphology and function also contribute to left ventricular hypertrophy and myocardial fibrosis [29]; indeed, hypertension and type 2 diabetes are common comorbidities. Accordingly, uncontrolled blood glucose levels and blood pressure are interlinked because of diabetes-related or hypertension-related cardiovascular complications associated primarily with microvascular function deterioration.…”