Considerations in Understanding the Coronary Blood Flow- Left Ventricular Mass Relationship in Patients with Hypertension

Abstract

Background: Coronary blood flow (CBF) is essential for optimal cardiac performance and to maintain myocardial viability. There is considerable ambiguity concerning CBF in hypertension.Objective: To investigate the relationship between CBF and left ventricular (LV) mass in persons with hypertension.Methods: OvidSP Medline was systematically searched. Eligible articles assessed CBF, and LV mass in adults with and without hypertension (HTN).Results: Eleven studies met the entry criteria. All 8 studies reported an increase in CBF (ml/min) for persons with hypertension (N=212) compared to individuals without hypertension (N=150). Meta-analysis showed a significant and 2.88 fold higher CBP in hypertension. Six studies adjusted CBF for LV mass; of which 4 studies reported a reduction in CBF. Meta-analysis showed a significant decrease in CBF/g LV mass in hypertension. The two studies that did not show a decrease in CBF, used the argon chromatographic method to measure coronary sinus blood flow suggesting this methodology may have influenced the results. Using the mean CBF in normotensive group to construct the expected CBF according to LV mass, reported CBF in HTN was progressively less than expected In two studies, (N=142), there was a significant inverse correlation between LV mass and CBF/ g LV mass. Multivariate analysis (three studies) consistently found a highly significant independent relationship between LV mass and CBF after considering age, sex, heart rate and several other factors.Conclusion: Hypertension is associated with a reduction in CBF adjusted for LV mass with a highly significant inverse association between CBF and LV mass. Clinicians should be aware that patients with hypertension are at greater risk for myocardial ischemia should develop other factors that limit CBF or myocardial oxygen delivery.

A patient‐specific approach to assessing blood pressure management in patients with hypertension and coronary artery disease

“…22 CBF is relatively reduced per gram LV mass in patients with LV hypertrophy. 11,23,24 Our data showed that the estimation of CBF using CCTA could…”

“…CBF is generally inversely related to the severity of coronary stenosis, recognizing there is little change in CBF with a minor degree of stenosis and the impact of high grade stenosis can be mitigated by collateral blood flow . CBF is relatively reduced per gram LV mass in patients with LV hypertrophy …”

“…CBF usually occurs during diastole and is driven by myocardial perfusion pressure (MPP), which is a function of DBP and the degree of coronary stenosis, which determines MPP distal to the stenosis . Another consideration is the amount of left ventricular mass, which not only is an indicator of myocardial oxygen requirements, but is also responsible for a relative reduction in CBF per gram of left ventricular mass . Thus, the management of patients with hypertension and coronary artery disease should integrate DBP, left ventricular mass, and MPP .…”

“…8,9 Another consideration is the amount of left ventricular mass, which not only is an indicator of myocardial oxygen requirements, but is also responsible for a relative reduction in CBF per gram of left ventricular mass. 10,11 Thus, the management of patients with hypertension and coronary artery disease should integrate DBP, left ventricular mass, and MPP. 12 Precise measurements of MMP are not reasonable or practical in clinical hypertension treatment as it requires blood pressure measurements distal to the coronary stenosis.…”

Exploring a New Natural Treating Agent for Primary Hypertension: Recent Findings and Forthcoming Perspectives

“…Basically, the body undertakes the regulation of blood-pressure via two strategies: total blood volume and blood flow. Total blood volume is mainly mediated by renin-angiotensin-aldosterone systems (RAAS), while blood flow is predominantly regulated by neurogenic hypertensive system and nitric oxide (NO) [30,31]. Consequently, current hypertensive medication also targets the aforementioned mechanisms (RAAS and neurogenic hypertensive system) to alleviate high blood pressure [1].…”