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Experimental and clinical studies have established a link between end-organ damage in hypertensive patients and the severe impairment of tissue perfusion and microcirculation structure and function. Microvascular rarefaction is constantly observed in hypertension, and probably contributes to higher systemic resistance and lower tissue perfusion. Endothelial dysfunction leading to impaired arteriolar reactivity is also characteristic of the microvascular dysfunction in hypertensive patients. The effective lowering of blood pressure while maintaining optimal tissue perfusion is therefore one of the major goals of antihypertensive therapy, in order to improve the cardiovascular prognosis of hypertensive patients.