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

Authors :
Marija Zdravkovic
Viseslav Popadic
Slobodan Klasnja
Andrea Klasnja
Tatjana Ivankovic
Ratko Lasica
Dragan Lovic
Drasko Gostiljac
Zorana Vasiljevic
Source :
Medicina, Vol 59, Iss 12, p 2149 (2023)
Publication Year :
2023
Publisher :
MDPI AG, 2023.

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.

Details

Language :
English
ISSN :
16489144 and 1010660X
Volume :
59
Issue :
12
Database :
Directory of Open Access Journals
Journal :
Medicina
Publication Type :
Academic Journal
Accession number :
edsdoj.6649dc874baf4323a2b944b7214144b7
Document Type :
article
Full Text :
https://doi.org/10.3390/medicina59122149