Hypertensive Heart Disease

Hypertensive Heart Disease: A Narrative Review Series—Part 3: Vasculature, Biomarkers and the Matrix of Hypertensive Heart Disease

“…Myocardial ischemia in HHD can be induced by a variety of factors, relates to the degree of increase in left ventricular (LV) mass and has important clinical implications [6]. At the beginning of the development of HHD, coronary flow may be increased because of higher BP, greater LV end-systolic stress, and LV hypertrophy (LVH).…”

“…On the one hand, the presence of LVH could be associated with decreased vascular density, which seems to result from inadequate angiogenesis. The direct compression of the endocardial capillaries can result as a response to the increasing muscle mass [6,20]. Breisch and colleagues studied the effects of pressure overload hypertrophy in the LV myocardium at different times after constriction of the aorta in adult cats, and found that the capillary density and coronary reserve decreased with the increasing extent of hypertrophy.…”

“…Breisch and colleagues studied the effects of pressure overload hypertrophy in the LV myocardium at different times after constriction of the aorta in adult cats, and found that the capillary density and coronary reserve decreased with the increasing extent of hypertrophy. The authors assumed that such alterations in flow reserve and capillary density might play an important role in the transition from a compensated to a failing heart [6,21]. Tomanek et al also showed that lateonset HTN in middle-aged and senescent rats is characterized by microvascular alterations, including decrements in numerical density and the inadequate growth of capillaries that reflect an absolute reduction in the number of these vessels in the context of the presence of cardiocyte hypertrophy [22].…”

“…Like the progression of myocardial remodeling, structural alterations in the coronary microvasculature also continue to develop and are related to BP burden. Some experimental and epidemiological data support the hypothesis that the increased CV risk associated with HDD is in part due to myocardial ischemia, which can be induced by a variety of factors leading to a decreased coronary reserve [6]. The presence of LVH is one of these factors predisposing one to functional and structural changes in the myocardium, including impaired coronary hemodynamics with reduced coronary blood flow and reserve [7].…”

“…The presence of LVH is one of these factors predisposing one to functional and structural changes in the myocardium, including impaired coronary hemodynamics with reduced coronary blood flow and reserve [7]. Concurrently, atherosclerosis of large arteries and increased resistance of muscular arterioles increase the afterload, leading to hypertrophy of cardiomyocytes [6].…”