Systolic ventricular dysfunction and heart failure due to coronary microangiopathy in hypertensive heart disease

Am J Cardiol. 1995 Nov 2;76(13):48D-53D. doi: 10.1016/s0002-9149(99)80492-5.


Left ventricular hypertrophy in arterial hypertension is characterized by myocyte hypertrophy, myocardial fibrosis, and structural changes of the intramural coronary arteries. Hypertensives with or without left ventricular hypertrophy have a reduced coronary vasodilator reserve due to alterations of the coronary microcirculation. The impairment in coronary vasodilator reserve is likely to initiate a process of malperfusion and malnutrition concomitant with increased metabolic demands. Further, malperfusion is supported by an increase in diastolic filling pressure, which will enhance the extravascular component of coronary resistance. The sum of interactions of these structural alterations of myocardium, interstitium, and coronary vasculature are likely to initiate and maintain a process of myocardial malperfusion and malnutrition, which can provoke functional depression of the myocardial performance, a loss of contractile proteins, an increase in interstitial fibrosis, and, not least, an overall decrease in contractile function in long-standing cardiac hypertrophy. Finally, the reversal of these processes by adequate antihypertensive treatment may contribute to renormalization of cardiac function and to prevention of late cardiac failure in hypertensive heart disease.

Publication types

  • Review

MeSH terms

  • Antihypertensive Agents / therapeutic use
  • Coronary Circulation / drug effects
  • Coronary Disease / drug therapy
  • Coronary Disease / etiology*
  • Endomyocardial Fibrosis / etiology
  • Endomyocardial Fibrosis / prevention & control
  • Heart Failure / etiology*
  • Heart Failure / prevention & control
  • Humans
  • Hypertension / complications*
  • Hypertension / drug therapy
  • Microcirculation / drug effects
  • Myocardial Contraction
  • Myocardial Ischemia / etiology
  • Myocardial Ischemia / prevention & control
  • Systole
  • Vasodilation
  • Ventricular Dysfunction, Left / etiology*
  • Ventricular Dysfunction, Left / prevention & control
  • Ventricular Pressure / drug effects


  • Antihypertensive Agents