Organ protection: benefit from antihypertensive treatment?

Patients with arterial hypertension often have angina pectoris and a positive exercise tolerance test, even when their epicardial coronary arteries are of normal anatomic appearance. In these patients, coronary vasodilator capacity is frequently impaired by 30-50%, predominantly owing to microvascular alterations. These include medical thickening, decreased capillary density, perivascular fibrosis, and an impaired endothelium-dependent coronary vasodilation. An antihypertensive treatment that can be considered cardioreparative restores myocardial structure through both regression of myocardial fibrosis and regression of the structural coronary microvascular alterations. We believe that this is the first clinical study to show that coronary flow reserve was considerably improved after long-term medical blood pressure normalization.