[Interaction of the coronary macro- and microcirculation]

Area of Science:

• Cardiovascular Medicine
• Vascular Biology
• Hypertension Research

Context:

• Coronary artery disease (CAD) primarily affects epicardial vessels, but its impact on the coronary microvasculature is significant.
• Microvascular dysfunction is increasingly recognized as a key component in the pathophysiology of cardiovascular diseases.
• Hypertension is a major risk factor for cardiovascular disease, impacting both large and small arteries.

Purpose:

• To review the bidirectional relationship between epicardial coronary arteries and the coronary microvasculature.
• To explore how epicardial vessel disease influences microvascular function.
• To examine the impact of microvascular disease, particularly in hypertension, on epicardial arteries.

Summary:

• Epicardial coronary artery disease (CAD) leads to microvascular dysfunction through flow limitation and microembolization of atherosclerotic material.
• Hypertensive microvascular disease is associated with impaired epicardial vessel tone regulation, even with normal angiograms.
• Patients with hypertensive microvascular disease exhibit a significantly higher incidence of epicardial CAD, suggesting a direct influence beyond hypertension itself.

Impact:

• Findings suggest that microvascular disease, independent of direct hypertensive effects, can affect upstream conduit arteries.
• Highlights the importance of assessing microvascular function in hypertensive patients, even those with initially normal coronary arteriograms.
• Recommends careful follow-up for hypertensive patients with preexistent microvascular disease to monitor for epicardial CAD development.