{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T15:42:09Z","timestamp":1793720529580,"version":"4.6.1"},"reference-count":124,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,12,11]],"date-time":"2023-12-11T00:00:00Z","timestamp":1702252800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Coronary microvascular dysfunction (CMD) is a clinical entity linked with various risk factors that significantly affect cardiac morbidity and mortality. Hypertension, one of the most important, causes both functional and structural alterations in the microvasculature, promoting the occurrence and progression of microvascular angina. Endothelial dysfunction and capillary rarefaction play the most significant role in the development of CMD among patients with hypertension. CMD is also related to several hypertension-induced morphological and functional changes in the myocardium in the subclinical and early clinical stages, including left ventricular hypertrophy, interstitial myocardial fibrosis, and diastolic dysfunction. This indicates the fact that CMD, especially if associated with hypertension, is a subclinical marker of end-organ damage and heart failure, particularly that with preserved ejection fraction. This is why it is important to search for microvascular angina in every patient with hypertension and chest pain not associated with obstructive coronary artery disease. Several highly sensitive and specific non-invasive and invasive diagnostic modalities have been developed to evaluate the presence and severity of CMD and also to investigate and guide the treatment of additional complications that can affect further prognosis. This comprehensive review provides insight into the main pathophysiological mechanisms of CMD in hypertensive patients, offering an integrated diagnostic approach as well as an overview of currently available therapeutical modalities.<\/jats:p>","DOI":"10.3390\/medicina59122149","type":"journal-article","created":{"date-parts":[[2023,12,11]],"date-time":"2023-12-11T11:24:43Z","timestamp":1702293883000},"page":"2149","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Coronary Microvascular Dysfunction and Hypertension: A Bond More Important than We Think"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4059-0263","authenticated-orcid":false,"given":"Marija","family":"Zdravkovic","sequence":"first","affiliation":[{"name":"Clinic for Internal Medicine, University Clinical Hospital Center Bezanijska Kosa, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0992-7481","authenticated-orcid":false,"given":"Viseslav","family":"Popadic","sequence":"additional","affiliation":[{"name":"Clinic for Internal Medicine, University Clinical Hospital Center Bezanijska Kosa, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6040-0183","authenticated-orcid":false,"given":"Slobodan","family":"Klasnja","sequence":"additional","affiliation":[{"name":"Clinic for Internal Medicine, University Clinical Hospital Center Bezanijska Kosa, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Klasnja","sequence":"additional","affiliation":[{"name":"Clinic for Internal Medicine, University Clinical Hospital Center Bezanijska Kosa, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatjana","family":"Ivankovic","sequence":"additional","affiliation":[{"name":"Clinic for Internal Medicine, University Clinical Hospital Center Bezanijska Kosa, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9033-5995","authenticated-orcid":false,"given":"Ratko","family":"Lasica","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Clinic of Cardiology, Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dragan","family":"Lovic","sequence":"additional","affiliation":[{"name":"Clinic for Internal Diseases Inter Medica, 18000 Nis, Serbia"},{"name":"School of Medicine, Singidunum University, 18000 Nis, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Drasko","family":"Gostiljac","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Clinic of Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zorana","family":"Vasiljevic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1038\/s41569-021-00559-8","article-title":"Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension","volume":"18","author":"Zhou","year":"2021","journal-title":"Nat. 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