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Cardiovascular Research 1998 40(1):4-8; doi:10.1016/S0008-6363(98)00174-6
© 1998 by European Society of Cardiology
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Copyright © 1998, European Society of Cardiology

Squeezing tubes: a case of remodeling and regulation

Coronary reserve in hypertensive heart disease

B Schwartzkopff* and B.E Strauer

Medical Clinic and Policlinic B, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany

* Corresponding author. Tel.: +49 (211) 811 8800; Fax: +49 (211) 811 8278.

Received 5 August 1997; accepted 28 April 1998

The first 150 words of the full text of this article appear below.


   1 Introduction
 
Essential hypertension is a main risk factor for left ventricular hypertrophy (LVH), ischemic heart disease and hypertensive cardiomyopathy [1]. In addition to the increased prevalence of atherosclerotic stenoses in epicardial arteries, hypertensive subjects with no relevant coronary artery disease or LVH have impaired coronary vasodilator reserve [2, 3]that has been reported to correlate with scintigraphic evidence of myocardial ischemia [4].

Impaired coronary reserve could be an important factor for inadequate delivery of oxygen and substrate to myocytes, precipitating myocardial ischemia and contributing to deterioration of myocardial function [2–4]. The potential mechanisms of impaired coronary reserve include abnormal processes of contraction and relaxation of a structurally remodeled myocardium, increased extravascular compressive forces, rheologic factors, metabolic factors as well as functional and structural alterations of the intramyocardial coronary arteries and arterioles (Fig. 1). The purpose of the present review is to discuss the pathophysiological mechanisms that . . . [Full Text of this Article]


   2 Physiological conditions of coronary circulation
 
2.1 Metabolic, myocardial and extravascular compressive factors, limiting coronary reserve in hypertension
2.2 Architecture of the intramyocardial coronary vessels in hypertensive heart disease
2.3 Endothelial function in the coronary microcirculation
2.4 Antihypertensive therapy and coronary microcirculation in man

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