Microvascular disease relevance in the hypertension syndrome.
Hypertension is not an isolated problem. Co-morbidities of smoking, obesity, diabetes and dyslipidemia are all associated with microvascular disease (MVD) with abnormal PET scan and endothelial dysfunction. MVD may contribute to left ventricular hypertrophy (LVH) via an imbalance between hyperplasia and apoptotic signals. Digitalis and other anti-hypertensive agents have anti-apoptotic action and MVD blunting effects, respectively. Heart failure progression must then be based on the preservation of myocyte integrity. Indeed, altered contractility appears to be a consequence of rather than the cause of myocyte deterioration. LV systolic dysfunction improvement is already a late strategy. Furthermore, the efficacy of anti-hypertension therapy may be limited in restoring LV diastolic function. Recognition of the role of apoptosis and MVD may initiate a paradigm shift in clinical practice.
Abarquez
Ramon F
RF
Department of Medicine, UP-Philippine General Hospital, Taft Avenue Manila, and Medical Center Manila, UN Avenue, Manila, Philippines. cvlab@cm.upm.edu.ph
D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000494:pharmacology / Q000627:therapeutic use; D017209:Apoptosis / Q000187:drug effects; D001943:Breast Neoplasms / Q000401:mortality / Q000503:physiopathology; D004071:Digitalis Glycosides / Q000494:pharmacology / Q000627:therapeutic use; D018450:Disease Progression; D004730:Endothelium, Vascular / Q000503:physiopathology; D006801:Humans; D006965:Hyperplasia; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000188:drug therapy / Q000209:etiology; D007333:Insulin Resistance; D024821:Metabolic Syndrome / Q000150:complications / Q000503:physiopathology*; D008833:Microcirculation; D009765:Obesity / Q000150:complications / Q000503:physiopathology
D000959:Antihypertensive Agents; D000970:Antineoplastic Agents; D004071:Digitalis Glycosides