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[Myocardial ischemia in hypertensive patients]
1Klinik für Innere Medizin, Carl-von-Basedow-Klinikum Merseburg.
Insights
Hypertensive patients with symptomatic myocardial ischemia have more severe ischemia than those with silent episodes alone. Lowering blood pressure to normal levels eliminated this difference, indicating blood pressure control is key.
Area of Science:
- Cardiology
- Hypertension Research
- Ischemic Heart Disease
Context:
- Hypertension is a major risk factor for cardiovascular diseases.
- Myocardial ischemia, often silent, poses a significant threat in hypertensive individuals.
- Understanding the severity differences between symptomatic and silent ischemia is crucial for risk stratification.
Purpose:
- To investigate the frequency and severity of myocardial ischemia in hypertensive patients with inadequately controlled blood pressure.
- To compare the degree of ischemia between patients experiencing silent episodes versus those with both silent and symptomatic episodes.
- To determine if blood pressure reduction impacts the severity of myocardial ischemia.
Summary:
- A study of 104 hypertensive patients using 24-hour ECG revealed myocardial ischemia.
- Patients with symptomatic episodes exhibited significantly higher ischemia severity (ST-total area) compared to those with silent episodes only.
- Following blood pressure normalization, the severity of ischemia decreased significantly in both groups, eliminating the difference between them.
Impact:
- This research highlights that symptomatic myocardial ischemia indicates greater severity in hypertensive patients.
- Effective blood pressure management can mitigate the severity of myocardial ischemia.
- Findings emphasize the importance of achieving normotensive blood pressure to reduce ischemic burden in hypertensive patients.
Aim:
To examine the frequency of myocardial ischemia in hypertensive patients with insufficiently adjusted blood pressure. It was to clarify the question if there is a difference between hypertensives with silent ischemic episodes alone and hypertensives with symptomatic episodes as well, referring to the degree of severity of ischemia. A resulting question was: if there is a difference between them, might it be possible to influence this by lowering the blood pressure?
Patients And Methods:
104 hypertensive patients had a check-up before and after the suspension of normotensive blood pressure by means of a 24-hour long-term ECG. Significant results for a myocardial ischemia were horizontal and descending ST segment depression > or = 0.1 mV for the duration > or = 1 min.
Results:
38 of the examined hypertensives showed 316 silent and 19 symptomatic episodes of myocardial ischemia. Hypertensives with additionally symptomatic episodes (n = 8) showed a severity of ischemia (ST-total area) which was significantly higher than in patients with only silent episodes (9.3 [2.7-65.3] mV min vs 2.6 [0.1-42.6] mV min, p < 0.05). After reduction of the blood pressure these patients as well as patients with silent episodes a lone (2.6 [0.1-42.6] mV min vs 0 [0 to 39.3] mV min, p < 0.0001) were found to have a decline of the ST-total area (9.3 [2.7-65.3] mV min vs. 0 [0-46.5] mV min, p < 0.05). There was no significant difference between them any longer.
Conclusion:
The severity of ischemia in insufficiently adjusted hypertensive patients with additionally symptomatic myocardial ischemia is higher than in the case of patients with silent episodes alone. After reaching a normotensive blood pressure again a difference was no longer evident.