Histologic characteristics of coronary artery in relation to the renovasculopathies of hypertension.

Coronary heart disease is a consequence of prior conditions in the coronary artery that invariably include atherosclerotic plaques with necrotic core. Evidence indicates that atheronecrosis is itself a late outcome of certain precursor conditions in the arteries, especially low density of intimal smooth muscle cells and extensive foam cell infiltration. A sequential process is indicated: the defined precursors set the conditions, atheronecrosis appears, and from this coronary heart disease eventually emerges. Hypertensive kidneys typically manifest intimal fibroplasia of cortical arteries and hyalinization of arterioles. Both forms of renovasculopathy, fibroplastic and hyaline, correlate with the early development of atheronecrosis and its precursor conditions. Hyalinization of renal arterioles, however, especially marks subjects with the greatest risk of further developing heart disease. These findings suggest an important prognostic significance to the finding of hyaline deposits in renocortical arterioles; the affected patient may be at exceptionally high risk for coronary heart disease. Results are derived from a series of forensic autopsies, in which morphometric assessment of paraffin sections of coronary arteries and renal cortex was performed.