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[Hypertension and the coronary circulation]
1I Cattedra di Cardiologia, Dipartimento di Scienze Cardiovascolari e Respiratorie, Università degli Studi La Sapienza, Roma. ffedele@axrma.uniromal.it
Insights
Systemic hypertension reduces coronary vasodilating reserve through several mechanisms, making myocardial ischemia diagnosis difficult. Exercise stress echocardiography is the preferred diagnostic tool for coronary stenosis in hypertensive patients.
Area of Science:
- Cardiology
- Hypertension Research
- Vascular Biology
Abstract:
The main alteration of coronary circulation in systemic hypertension is mostly dependent on the reduction of the coronary vasodilating reserve, due to various mechanisms: left ventricular hypertrophy, functional and structural alterations of the coronary microcirculation, anatomic modifications, and atherosclerosis of epicardial vessels. The role of endothelial dysfunction is important as well. Diagnosis of myocardial ischemia is, therefore, difficult in these subjects. The use of exercise ECG is limited by a high false positive incidence in diagnosing coronary stenosis, whereas exercise stress echocardiography, far more specific, may be considered the diagnostic tool of choice.