Abstract
Arterial hypertension represents the most frequent kind of left ventricular pressure overload in man. As former studies in our clinic have shown, three distinct types of left ventricular hypertrophy may occur: concentric — irregular — eccentric (1). The main functional features of these different types of hypertrophy imply: (I) Left ventricular systolic ejection fraction is normal, despite of significant or excessive increase in left ventricular muscle mass as long as ventricular volume is not increased. Diastolic function is impaired at all stages of LV hypertrophy. (II) There is an inverse relationship between systolic wall stress, i.e. left ventricular afterload, and left ventricular function. (Ill) Systolic wall stress is directly correlated with LV myocardial oxygen consumption. (IV) In hypertensive hypertrophy there is, even at normal coronary arteriogram, significant reduction in coronary reserve (2) (Fig. 1). Both, reduction in coronary reserve and diastolic dysfunction already may occur in the prehypertrophic state of hypertensive heart disease.
With support of SFB 242 “Koronare Herzkrankheit — Prävention und Therapie akuter Komplikationen.”
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References
Strauer BE: Ventricular function and coronary hemodynamics in hypertensive heart disease. Am J Cardiol 1979; 44: 999–1006
Strauer BE: Coronary hemodynamics in hypertensive heart disease. Am J Med 1988; 84: 45–54
Anversa P, Ricci R, Olivetti G: Quantitative structural analysis of the myocardium during physiologic growth and induced cardiac hypertrophy. A review. J Am Coll Cardiol 1986; 7: 1140–1149
Katz A: cardiomyopathy of overload. A major determinant of prognosis in congestive heart failure. N Engl J Med 1990; 322: 100–110
Nadal-Ginard B, Mahdavi V: Molecular mechanisms of cardiac gene expression, pp 65–80. In: Strauer BE (ed): The heart in Hypertension. Springer-Verlag, New York 1993
Capasso JM, Palackal T, Olivetti G, Anversa P: Left ventricular failure — induced by long-term hypertension in rats. Circ Res 1990; 66: 1400–1412
Weber KT, Sun Y, Guarda E: Structural remodeling in hypertensive heart disease and the role of hormones. Hypertension 1994; 23: 869–877
Schwartzkopff B, Motz W, Knauer S, Frenzel H, Strauer BE: Morphometric investigations of intramyocardial arterioles in right septal endomyocardial biopsy of patients with arterial hypertension and left ventricular hypertrophy. J cardiovasc Pharmacol, Suppl 1 1992; 20: 12–17
Tillmanns H, Steinhausen M, Leinberger H, Thederau H, Kubier W: Pressure measurement in the terminal vascular bed of the epicardium of rats and cats. Cir Res 1981; 49: 1202–1211
Mulvany MJ: Vascular growth in hypertension. J Cardiovasc Pharmacol 1992; 22: 7–11
Opherk D, Mall G, Zebe H et al: Reduction of coronary reserve. A mechanism for angina pectoris in patients with arterial hypertension and normal arteries. Circulation 1984; 69: 1–7
Schwartzkopff B, Motz W, Frenzel H et al.: Structural and functional alterations of the intramyocardial coronary arterioles in patients with arterial hypertension. Circulation 1993; 88: 993–1003
Hudlicka O, Brown M, Egginton S: Angiogenesis in skeletal and cardiac muscle. Physiol Rev 1992; 72: 369–417
Moritz AR, Oldt MR: Arteriolar sclerosis in hypertensive and non-hypertensive individuals. Am J Pathol 1937; 13:679–728
Dzau VJ, Gibbons GH, Cooke JP, Omoigui N: Vascular biology and medicine in the 1990s. Scope, concepts, potentials and perspectives. Circulation 1993; 87: 705–719
Scott-Burden T, Resink TJ, Baur U, Bürgin M, Bühler FR: Epidermal growth factor responsiveness in smooth muscle cells from hypertensive and normotensive rats. Hypertension 1989; 13: 295–304
James JN: Morphologic characteristics and functional significance of focal fibromuscular dysplasia of small coronary arteries. Am J Cardiol 1990; 65: 12G-22G
Schwartzkopff B, Frenzel H, Dieckerhoff J et al.: Morphometric investigation of humen myocardium in arterial hypertension and valvular aortic stenosis. Eur Heart J, Suppl D 1992; 13: 17–20
Schwartzkopff B, Motz W, Strauer BE: Repair of human myocardial structure by chronic treatment with ACE-inhibitors in hypertensive heart disease. Circulation Suppl. I 1994; 90: 343
Diez J, Laviades C, Mayor G, Gil MJ, Monreal I: Increased serum concentrations of procollagen peptides in essential hypertension. Relation to cardiac alterations. Circulation 1995; 91: 1450–1456
Motz W, Vogt M, Scheler S et al.: Prophylaxe mit gefäßaktiven Substanzen. Z Kardiol, Suppl. 4 1992; 81: 199–204
Motz W, Strauer BE: Improvement of coronary flow reserve after long-term therapy with Enalapril. Hypertension 1996; 27: 1031–1058
Vogt M, Motz W, Strauer BE: Antihypertensive Langzeittherapie mit Isradipin. Arzneimittel Forschung; 44: 1321–1318
Motz W, Vogt M, Scheler S, Schwartzkopff B, Strauer BE: Verbesserung der Koronarreserve nach Hypertrophieregression durch antihypertensive Therapie mit einem Beta-Rezeptorenblocker. Dtsch Med Wochenschr 1993; 118: 540–553
Brilla CG, Janicki JS, Weber KT: Cardioreparative effects of lisinopril in rats with genetic hypertension and left ventricular hypertrophy. Circulation 1991; 83: 1771–1779
Schiffrin EL, Deng LY, Larochelle P: Effects of a β-blocker or a converting enzyme inhibitor on resistance arteries in essential hypertension. Hypertension 1994; 23: 83–91
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Strauer, B.E., Schwartzkopff, B. (1997). Hypertension and Coronary Microvascular Disease. In: Zanchetti, A., Devereux, R.B., Hansson, L., Gorini, S. (eds) Hypertension and the Heart. Advances in Experimental Medicine and Biology, vol 432. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-5385-4_23
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DOI: https://doi.org/10.1007/978-1-4615-5385-4_23
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