Several studies have demonstrated that abnormalities in the function and structure of the coronary microcirculation occur in many clinical conditions, including arterial hypertension in which it might contribute to cardiovascular morbidity and mortality. This dysfunction is caused by remodelling of vascular and extravascular structures as well as abnormal coronary haemodynamics. Whether antihypertensive treatment can lead to reverse remodelling of the coronary microvasculature remains to be determined. The preliminary results of a recent study in patients with arterial hypertension and left ventricular hypertrophy show that 6 months' treatment with a combination of perindopril and indapamide is accompanied by a significant decrease in blood pressure and left ventricular mass and an increase in resting and hyperaemic myocardial blood flow measured non-invasively with positron emission tomography. This suggests that coronary microvascular dysfunction can be reversed by treatment with these drugs and might contribute to the prevention of ischaemic heart disease in these patients.