Functional and structural alterations of the coronary microcirculation and left ventricular hypertrophy represent the two key cardiac manifestations of arterial hypertension. In addition, qualitative changes in myocardial tissue composition and structure, such as reactive interstitial fibrosis, are frequently present. The extent of the impairment of coronary flow reserve can be measured using Doppler, argon gas chromatography or thermodilution techniques. Impaired flow reserve can be detected non-invasively using positron emission tomography. The combination of both a normal coronary angiogram and a positive exercise tolerance test (electrocardiogram or thallium) stongly indicates the presence of a hypertension-related disorder of the coronary microcirculation. Left ventricular hypertrophy can easily be quantified using echocardiography (Penn formula). Diastolic function can be assessed by measuring mitral inflow using pulsed-wave Doppler echocardiography (E/A ratio). Non-invasive assessment of myocardial structural alterations may be possible in the future using backscatter echocardiography.
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