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Transient myocardial ischemia in hypertensive heart disease
1Department of Medicine, University of Duesseldorf, Federal Republic of Germany.
Insights
Transient myocardial ischemia frequently occurs in hypertensive patients with normal coronary arteries. Left ventricular hypertrophy is not a major factor, suggesting vascular alterations are the cause.
Area of Science:
- Cardiology
- Hypertension Research
- Vascular Biology
Background:
- Essential arterial hypertension is a risk factor for cardiovascular events.
- Coronary artery disease is a common cause of myocardial ischemia.
- The occurrence of myocardial ischemia in hypertensive patients without coronary stenosis is not well understood.
Purpose of the Study:
- To investigate the presence of transient myocardial ischemia in patients with essential arterial hypertension and normal coronary angiograms.
- To explore the relationship between left ventricular hypertrophy and myocardial ischemia in this patient group.
- To identify potential underlying causes of myocardial ischemia in hypertensive individuals with unobstructed coronary arteries.
Main Methods:
- 24-hour Holter electrocardiography with ST-segment analysis was performed on 48 hypertensive patients.
- Echocardiography was used to measure left ventricular posterior wall and septum thickness.
- Coronary angiography excluded significant coronary artery stenosis in all participants.
Main Results:
- Transient myocardial ischemia was observed in 50% of the hypertensive patients (24 out of 48).
- These ischemic episodes often occurred without symptoms of angina pectoris (95% of episodes).
- Left ventricular hypertrophy did not significantly differ between patients with and without ischemia, suggesting it's not a primary driver.
Conclusions:
- Transient myocardial ischemia is a common finding in hypertensive patients even with normal coronary angiograms.
- Left ventricular hypertrophy does not appear to play a significant role in the occurrence of ischemia in this population.
- Impaired coronary vasodilation capacity due to vascular alterations is likely the underlying cause of myocardial ischemia in these patients.
Abstract:
This study determined whether episodes of myocardial ischemia occur in hypertensive patients with normal coronary angiograms. ST-segment analysis during 24-hour Holter electrocardiography was determined in 48 patients (24 men and 24 women, mean age 54.6 +/- 10.4 years) with essential arterial hypertension (systolic/diastolic blood pressure 189.7 +/- 29/99.5 +/- 15 mm Hg). The thickness of left ventricular posterior wall and septum were measured with echocardiography. Stenosis of coronary vessels were excluded on angiography in all patients. In 24 of 48 patients, 12.8 +/- 13.8 episodes of transient myocardial ischemia (ST-segment depression greater than or equal to 1 mm, duration of the episode greater than or equal to 1 minute) were observed. The duration of the episodes was 48.1 +/- 69.93 minutes and the maximal ST-segment depression was 1.91 +/- 0.82 mm. In 95% of the episodes the patients did not experience any angina pectoris. The degree of left ventricular wall thickness did not differ in hypertensive patients with and without transient myocardial ischemia (septum thickness 11 +/- 2 mm). It is concluded that transient myocardial ischemia often occurs in hypertensive patients. Thus, left ventricular hypertrophy does not appear to play any important role. The underlying cause appears to be the impaired coronary dilation capacity, i.e., vascular alterations.