Do coronary circulation abnormalities play an important role in the pathogenesis of hypertensive left ventricular hypertrophy?

Hypertensive left ventricular hypertrophy (LVH) is a powerful predictor of coronary events. It is characterized by coronary circulation abnormalities such as impaired coronary blood flow autoregulation, decreased coronary reserve, increased minimal coronary vascular resistance, subendocardial under-perfusion during exercise, and increased risk of myocardial infarction and death in the presence of coronary occlusion. These abnormalities appear to play a significant role in the pathogenesis of cardiac complications in arterial hypertension. Although the imbalance between coronary supply and myocardial needs has often been incriminated in the pathogenesis of hypertensive LVH, no convincing evidence has been provided to date that LVH is the consequence, rather than the cause, of a primary defect of myocardial perfusion in hypertensive patients.