Hypertension and the coronary circulation

: The main alteration of coronary circulation in systemic hypertension is mostly dependent on the reduction of the coronary vasodilating reserve, due to various mechanisms: left ventricular hypertrophy, functional and structural alterations of the coronary microcirculation, anatomic modifications, and atherosclerosis of epicardial vessels. The role of endothelial dysfunction is important as well. Diagnosis of myocardial ischemia is, therefore, difficult in these subjects. The use of exercise ECG is limited by a high false positive incidence in diagnosing coronary stenosis, whereas exercise stress echocardiography, far more specific, may be considered the diagnostic tool of choice.