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Published on: July 21, 2023
Coronary Microvascular Dysfunction and Hypertension: A Bond More Important than We Think
Marija Zdravkovic1,2, Viseslav Popadic1, Slobodan Klasnja1
1Clinic for Internal Medicine, University Clinical Hospital Center Bezanijska Kosa, 11000 Belgrade, Serbia.
Insights
Coronary microvascular dysfunction (CMD) in hypertension causes heart damage and angina. Early diagnosis and treatment are crucial for managing this condition and preventing heart failure.
Area of Science:
- Cardiology
- Hypertension Research
- Vascular Biology
Background:
- Coronary microvascular dysfunction (CMD) is a significant factor in cardiac morbidity and mortality, often linked to hypertension.
- Hypertension induces functional and structural microvascular changes, leading to microvascular angina through endothelial dysfunction and capillary rarefaction.
- CMD is associated with myocardial changes like left ventricular hypertrophy and diastolic dysfunction, serving as a marker for heart failure with preserved ejection fraction.
Purpose of the Study:
- To review the pathophysiological mechanisms of CMD in hypertensive patients.
- To provide an integrated diagnostic approach for CMD.
- To offer an overview of current therapeutic strategies for CMD.
Main Methods:
- Comprehensive literature review focusing on CMD pathophysiology, diagnosis, and treatment in hypertensive individuals.
- Analysis of diagnostic modalities, including non-invasive and invasive techniques.
- Evaluation of therapeutic options and their impact on prognosis.
Main Results:
- Hypertension significantly contributes to CMD via endothelial dysfunction and capillary rarefaction.
- CMD is an early indicator of end-organ damage and heart failure, particularly in hypertensive patients.
- Numerous diagnostic tools exist to assess CMD severity and guide treatment.
Conclusions:
- CMD in hypertensive patients is a critical clinical entity requiring thorough investigation.
- Screening for microvascular angina is essential in hypertensive patients with chest pain and no obstructive coronary artery disease.
- An integrated diagnostic and therapeutic approach is vital for managing CMD and improving patient outcomes.
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.
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