Fibrosis and hypertensive heart disease

The normal myocardium is composed of a variety of cells: cardiac myocytes a nd noncardiomyocytes, which include endothelial and vascular smooth muscle cells and fibroblasts. Hypertensive heart disease involves a structural rem odeling of muscular and nonmuscular compartments. It is not the quantity bu t rather the quality of myocardium that accounts for pathologic hypertrophy and predisposes to ventricular dysfunction and arrhythmias, which, in turn , confer increased risk of adverse cardiovascular events. Herein, factors r egulating growth of these compartments are reviewed and in particular signa ls involved in promoting adverse remodeling of intramyocardial coronary art eries and arterioles by fibrous tissue. (C) 2000 Lippincott Williams & Wilk ins, Inc.