Can differences in cerebral and coronary autoregulation and O2-extraction explain why antihypertensive treatment prevents stroke but not myocardial infarction?

It is proposed that the failure of current antihypertensive treatment to reduce the incidence of coronary heart disease in patients with hypertension is due to severe, possibly irreversible restriction of coronary vascular reserve in the deeper layers of the left ventricle. Contrary to the heart, the brain can maintain a normal oxidative metabolism when the blood pressure is lowered, by extracting more oxygen from the blood. The brain is thus better suited than the heart to take advantage of the beneficial effect of antihypertensive treatment in terms of protection against hypertensive organ damage. This hypothesis is supported by studies of cerebral and coronary autoregulation and the J-shaped relation between death from myocardial infarction and treated diastolic blood pressure now reported from a number of studies.