The influence of arterial hypertension on the development of coronary artery disease in angiographic findings

Abstract

Arterial hypertension is considered to be, together with cigarette smoking, hyperlipidaemia and diabetes one of the main risk factors of the onset of atherosclerosis. In the paper the authors reviewed the studies, not very frequent in the literature, concerning the angiographic picture of the coronary artery atherosclerosis found in individuals with arterial hypertension. In patients with arterial hypertension the atherosclerotic lesions are usually more advanced than in normotensive subjects, this fact suggests a more rapid progression of atherosclerosis under influence of the hypertensive disease. Scarce data indicates specific morphologic characteristics of the atherosclerotic lesions found in patients with concomitant arterial hypertension compared to the morphology of atherosclerotic lesions found in patients with other risk factors. The results of many studies suggest that hypertension causes an impairment of blood flow, diminishing the coronary flow reserve, which is to a great extent responsible for the symptoms of ischemic heart disease, even when no significant atherosclerotic lesions in coronary arteries are present. Many studies indicate that the flow impairment results from endothelium dysfunction and consequent less efficient adaptation of the vessels to the augmented myocardial oxygen demand. Some reviews suggest that the administration of antihypertensive drugs may improve myocardial blood supply not only because of their blood pressure-lowering effects but also due to their direct influence on vessels (inhibition of vasoconstriction, flow improvement).