Coronary vasodilator reserve in untreated and treated hypertensove patients with and without left ventricular hypertrophy

Abstract

The reduction in coronary reserve observed in untreated hypertensive patients with normal myocardial mass suggests that structural abnormalities of the coronary microvasculature may occur before left ventricular hypertrophy. Treated patients with normal mass before treatment had a coronary reserve comparable to that of normotensive control subjects, whereas normalization of arterial pressure with persistent left ventricular hypertrophy was associated with a marked impairment of coronary reserve.

Cardiac and vascular remodelling: effect of antihypertensive agents

“…The relative roles of atherosclerosis, myocardial fibrosis, alteration of coronary reserve, or other factors to explain these outcomes remain to be established. [27][28][29][30][31][32][33][34][35] An association between the presence of LVH and the risk of cerebrovascular accidents has been reported. 36 Likewise, more severe retinopathy and increased proteinuria have been shown in patients with LVH, and in particular, with concentric hypertrophy.…”

Clinical Implications of Assessing Coronary Flow Velocity Reserve and Plasma Endothelin-1 in Hypertensive Patients

“…A number of reports published in the past decade have described a reduction in CFVR in hypertensive patients (3,12,18,19) that was thought to arise during advanced stages of disease, when left ventricular hypertrophy (LVH) becomes obvious (20,21). However, recent reports have suggested that CFVR is decreased even at early disease stages in hypertensive patients without LVH (18,19).…”

The imbalance between coronary reserve and wall stress explains the severity of ventricular dysfunction in hypertension

“…6,27,28 In diabetes mellitus and HTN, structural microvascular changes correlated with impaired coronary vasodilatation. 9,29 Apparently in contradiction with our results, coronary reserve impairment has been reported early in the development of human HTN 7 and has been implicated in subsequent cardiac dysfunction.…”

“…[3][4][5] The impairment of coronary reserve has been documented in patients both with and without left ventricular (LV) hypertrophy 6 and even in young patients with borderline hypertension. 7 Decreased cross-sectional area of resistance arterioles, accumulation of vascular collagen, and reduction in capillary density were all implied as the major causes of reduced vasodilator capacity.…”