Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

Coronary Microvascular Dysfunction and Hypertension: A Bond More Important Than We Think

Marija Zdravkovic
ORCID logo ,
Viseslav Popadic
* ORCID logo ,
Slobodan Klasnja
ORCID logo ,
Andrea Klasnja
,
Tatjana Ivankovic
,
Ratko Lasica
ORCID logo ,
Dragan Lovic
,
Drasko Gostiljac
,
Zorana Vasiljevic
Version 1 : Received: 16 November 2023 / Approved: 17 November 2023 / Online: 17 November 2023 (15:28:27 CET)

A peer-reviewed article of this Preprint also exists.

Zdravkovic, M.; Popadic, V.; Klasnja, S.; Klasnja, A.; Ivankovic, T.; Lasica, R.; Lovic, D.; Gostiljac, D.; Vasiljevic, Z. Coronary Microvascular Dysfunction and Hypertension: A Bond More Important than We Think. Medicina 2023, 59, 2149. Zdravkovic, M.; Popadic, V.; Klasnja, S.; Klasnja, A.; Ivankovic, T.; Lasica, R.; Lovic, D.; Gostiljac, D.; Vasiljevic, Z. Coronary Microvascular Dysfunction and Hypertension: A Bond More Important than We Think. Medicina 2023, 59, 2149.

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-related 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 the one 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, but also to investigate additional complications that can affect further prognosis, especially among those with hypertensive heart disease. Although various pharmacological and interventional treatments demonstrated certain clinical effects, integrated diagnostic and therapeutic algorithms are necessary to reduce the burden of this emerging condition.

Keywords

coronary microvascular dysfunction; hypertension; hypertensive heart disease; myocardial fibrosis; heart failure

Subject

Medicine and Pharmacology, Cardiac and Cardiovascular Systems

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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