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[Myocardial ischemia in hypertensive patients--pathogenesis, prevalence and prognosis]
1Klinik für Innere Medizin des Carl-von-Basedow-Klinikums Merseburg.
Insights
Lowering high blood pressure significantly reduces myocardial ischemia episodes in hypertensive patients. Antihypertensive treatment improves cardiac health and reduces the risk of ischemic events.
Area of Science:
- Cardiology
- Hypertension Research
- Ischemic Heart Disease
Context:
- Arterial hypertension leads to myocardial hypertrophy and coronary circulation issues, increasing predisposition to atherosclerotic coronary artery disease.
- Hypertension significantly impacts coronary circulation, causing structural and functional changes that elevate the risk of heart disease.
Purpose:
- To investigate the frequency of myocardial ischemia and its changes following medical blood pressure reduction in hypertensive patients.
- To assess the impact of antihypertensive therapy on myocardial ischemia in individuals with inadequately controlled blood pressure.
Summary:
- A study involving 104 hypertensive patients with uncontrolled blood pressure monitored myocardial ischemia using 24-hour long-term ECG before and after blood pressure reduction.
- Before treatment, 38 patients experienced 335 ischemic episodes (94% silent). After lowering blood pressure (181.0/98.7 mmHg to 136.4/78.2 mmHg), ischemic episodes reduced significantly (median 5 to 0, p < 0.0001), as did the ST-total area (median 3.8 mV.min to 0 mV.min, p < 0.0001).
Impact:
- Antihypertensive drug treatment effectively reduces the incidence and severity of myocardial ischemic attacks.
- Lowering blood pressure through medication is crucial for improving the prognosis of patients with hypertension and coronary artery disease.
Abstract:
Arterial hypertension causes myocardial hypertrophy and affects coronary circulation through structural and functional changes of the coronaries. Therefore, the presence of arterial hypertension predisposes to atherosclerotic coronary artery disease. We examined the frequency of myocardial ischemia as well as their changing by means of medical blood pressure reduction in the case of 104 hypertensives with insufficiently adjusted blood pressure results. The 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. Before starting the treatment there were 38 patients with 335 ischemic episodes. The percentage of silent ischemic episodes was very high (94%). After lowering blood pressure 181.0 +/- 8.8 mmHg./98.7 +/- 9.7 mmHg vs. 136.4 +/- 11.5 mmHg./78.2 +/- 14.1 mmHg a reduction of the number of ischemic episodes (median 5 vs. 0, p < 0.0001) could be shown as well as a reduction in the ST-total area per patient (median 3.8 mV.min vs. 0 mV.min, p < 0.0001)--the decisive parameter for evaluation of the grade of the severity of ischemia. The danger of ischemic attacks respectively the total ischemic burden is reduced by antihypertensive drug treatment. This is important for the prognosis.