From the Guidelines
Chronic microvascular ischemia and hypertension should be managed with a focus on controlling blood pressure to a target of less than 130/80 mmHg, using lifestyle changes and medications such as RAS blockers, beta-blockers, and calcium channel blockers, as recommended by the 2020 international society of hypertension global hypertension practice guidelines 1. The relationship between chronic microvascular ischemia and hypertension is complex, with hypertension being a major contributor to the development and progression of microvascular disease.
- Key factors in the management of these conditions include:
- Lifestyle modifications, such as smoking cessation, diet, and exercise, to reduce blood pressure and slow disease progression.
- Medications, including RAS blockers, beta-blockers, and calcium channel blockers, which are recommended as first-line treatments for hypertensive patients with coronary artery disease 1.
- Lipid-lowering treatment with a target LDL-C of less than 55 mg/dL, to reduce the risk of cardiovascular events.
- Antiplatelet treatment with acetyl salicylic acid, which is routinely recommended for patients with high cardiovascular risk. The goal of treatment is to reduce morbidity and mortality by controlling blood pressure, improving cardiovascular health, and preventing complications such as stroke, heart attack, and kidney failure.
- Regular monitoring of blood pressure and follow-up appointments are essential to ensure that treatment goals are being met and to make adjustments to the treatment plan as needed. By prioritizing blood pressure control and adopting a comprehensive approach to management, patients with chronic microvascular ischemia and hypertension can reduce their risk of serious complications and improve their overall quality of life, as supported by the 2020 international society of hypertension global hypertension practice guidelines 1.
From the Research
Chronic Microvascular Ischemia and Hypertension
- Chronic microvascular ischemia is a condition where the small blood vessels in the body become narrowed or blocked, reducing blood flow to the heart and other organs 2.
- Hypertension, or high blood pressure, is a major risk factor for chronic microvascular ischemia, as it can cause damage to the blood vessels and increase the risk of blockages 3, 4, 5.
- Studies have shown that certain medications, such as angiotensin-converting enzyme inhibitors (ACEIs) and calcium channel blockers (CCBs), can help to improve blood flow and reduce blood pressure in patients with chronic microvascular ischemia and hypertension 3, 2, 6.
Treatment Options
- ACEIs have been shown to be effective in improving microvascular function and reducing symptoms of ischemia in patients with chronic microvascular ischemia and hypertension 2, 6.
- CCBs have also been shown to be effective in reducing blood pressure and improving blood flow in patients with hypertension, although their effectiveness in treating chronic microvascular ischemia is less clear 3, 4, 5.
- Combination therapy with ACEIs and CCBs may be more effective than monotherapy in improving metabolic, renal, and cardiovascular outcomes in patients with hypertension 3.
Mechanisms and Outcomes
- The renin-angiotensin system plays a key role in the development of chronic microvascular ischemia and hypertension, and inhibition of this system with ACEIs may help to improve microvascular function and reduce symptoms of ischemia 6.
- Improvement in microvascular function with ACEI therapy has been associated with reduction in angina symptoms and improvement in quality of life 6.
- The beneficial response of the coronary microvasculature to ACEI therapy may be limited to patients with more severe microvascular defects, suggesting that early treatment may be important in preventing long-term damage 6.