[Silent myocardial ischemia in hypertensive patients]

Silent myocardial ischemia occurs in hypertensive individuals with a prevalence of approximately 35%. ST-alterations are triggered by a) hypertensive peaks and b) heart rate increase. Like in patients with coronary heart disease most ischemic events occur without angina. They are clinically silent. In daily practice silent myocardial ischemia may be detected by ECG under physical load or with 24 h Holter ECG-monitoring. The latter can detect ischemic events missed by ECG-monitored exercise tolerance. In hypertensive patients the simultaneous, ST-triggered recording of ECG and blood pressure data is more meaningful. Patients with silent ischemia are at higher risk than individuals without. Angor is not as strong a determinant of risk as silent ischemia. Hypertensive patients without coronary artery disease (CAD) who have silent ischemia may even have a worse prognosis than those with known CAD. It is therefore important to substantiate the objective extent of silent ischemia by ST-analysis. If detected it has to be included into therapeutic considerations with the goal to prevent such episodes by antihypertensive treatment.