Left ventricular hypertrophy and coronary microcirculation in hypertensive heart disease

Hypertensive heart disease is a major factor for left ventricular hypertrophy, the development of ischaemic syndromes, including coronary macro- and microangiopathy, and heart failure. Coronary microcirculation is impaired very early in the process of hypertensive heart disease, giving suspect that impaired coronary reserve is an early indicator for the conversion from the normal into the pathologic status. Alterations at the level of the interstitium with accumulation of collagen, of the intramyocardial resistance vessels with remodelling or hypertrophy of the vessel wall, of the endothelium with reduced vasodilators and increased vasoconstrictors as well as of the capillaries with a reduction in their numbers may all be involved in the process of the impaired coronary reserve. Therapeutic interventions by antihypertensive therapy can improve coronary reserve.