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Is there an association between hypertension and the development of coronary collateral flow?

Journal of Human Hypertension volume 19, pages 757–759 (2005)Cite this article

The coronary collateral circulation is present in all individuals, whether or not obstructive coronary artery disease is present.1 In the majority of individuals, this extensive collateral network is not visible at contrast coronary angiography, as it is microscopic. The presence of this circulation using post-mortem angiography has been clearly demonstrated, including the confluence of the subendocardial plexus—this collateral circulation is particularly relevant in occlusive coronary artery disease.1

It is important to differentiate the collateral circulation from that which develops by angiogenesis. The former is present from birth and is affected by the intrauterine environment2 (ie, the microcirculation and connections being already established), and has a variable capacity to develop by arteriogenesis. Alternatively, de novo angiogenesis requires endothelial cell invasion and migration to develop new channels. This process takes time and these vessels, which begin as capillary outgrowths, are not immediately effective as conduits. Studies with exogenous vascular endothelial growth factor (a potent angiogenic growth factor) administered directly into cardiac tissue while being able to demonstrate a response have not shown a useful clinical impact.3 Regardless of these facts, angiogenesis is strongly linked to the pathophysiology of hypertension,4 and is part of the triad of abnormalities involving angiogenesis, thrombogenesis and atherogenesis in vascular disease.5

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  1. University Department of Medicine, Haemostasis Thrombosis and Vascular Biology Unit, City Hospital, Birmingham, UK

    M H Tayebjee, G Y H Lip & R J MacFadyen

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  1. M H Tayebjee
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  2. G Y H Lip
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  3. R J MacFadyen
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Correspondence to R J MacFadyen.

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Tayebjee, M., Lip, G. & MacFadyen, R. Is there an association between hypertension and the development of coronary collateral flow?. J Hum Hypertens 19, 757–759 (2005). https://doi.org/10.1038/sj.jhh.1001906

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