Hypertensive heart disease: cardioreparation by reversal of interstitial collagen in patients.

Abstract

Impairment of coronary flow reserve in arterial hypertension and hypertrophy is caused by multiple mechanisms. Medial wall thickening of the small intramural arteries and rarification of capillarization are the major structural alterations in hypertensive hypertrophy. Since the small intramural resistance arteries contribute more to coronary resistance than capillaries, medial wall thickening of the intramyocardial arterioles has to be considered the most relevant mechanism for causing impaired coronary flow reserve in arterial hypertension. Additionally, qualitative changes in myocardial tissue composition and structure, such as reactive interstitial fibrosis, rather than the mere augmentation of the myocardial muscle mass, impair flow reserve extravascularly. Except for the structural vascular and myocardial changes, in some hypertensive patients an impaired endothelium-mediated vasodilation of the microvessels occurs. Preliminary clinical data indicate that myocardial interstitial collagen content can be regressed in some hypertensive patients by clinical antihypertensive therapy over a period of 9-12 months.