[Myocardial ischemia in hypertensive patients]

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?

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.

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.

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.