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Inadequate Blood Pressure Control in Hypertensive Patients Referred for Cardiac Stress Test
Tarek M Mousa1, Oluwaseun A Akinseye2, Todd C Kerwin3
1Queens Heart Institute, Laurelton.
Insights
Hypertension management is key for cardiac health. This study found that while very poorly controlled blood pressure in hypertensive patients was linked to lower ischemia rates, optimal BP control is crucial before cardiac testing.
Area of Science:
- Cardiology
- Hypertension Research
- Diagnostic Testing
Background:
- Hypertension affects a significant portion of the adult population.
- Myocardial ischemia is a major concern in patients with uncontrolled blood pressure.
- Cardiac stress tests are commonly used to diagnose ischemia in at-risk patients.
Purpose of the Study:
- To investigate the relationship between blood pressure control levels and myocardial ischemia incidence in hypertensive patients.
- To evaluate the prevalence of different blood pressure control categories in patients undergoing cardiac stress tests.
- To inform clinical practice regarding the optimal management of hypertension in patients with suspected ischemic heart disease.
Main Methods:
- A cohort of 2039 hypertensive patients referred for cardiac stress testing was analyzed.
- Patients were stratified into well-controlled (<140/90 mmHg), poorly controlled (140-160/90-100 mmHg), and very poorly controlled (>160/100 mmHg) resting blood pressure groups.
- Incidence of myocardial ischemia was assessed in each group.
Main Results:
- Prevalence of hypertension control: 47.2% well-controlled, 29.5% poorly controlled, 23.3% very poorly controlled.
- Ischemia evidence: 19.8% in well-controlled, 19.3% in poorly controlled groups.
- The very poorly controlled group exhibited the lowest ischemia incidence (14.3%, P<.05).
Conclusions:
- Symptoms mimicking ischemic heart disease may be partly attributed to poorly controlled blood pressure.
- Optimizing blood pressure control in hypertensive patients with angina symptoms before diagnostic testing is recommended.
- Improved quality of care can be achieved by prioritizing blood pressure management to potentially reduce unnecessary radiation exposure and costs associated with cardiac testing.
Abstract:
The current study examined the degree of blood pressure (BP) control and incidence of myocardial ischemia in hypertensive patients (n=2039) referred for cardiac stress test. Patients were categorized into well-controlled (<140/90 mm Hg), poorly controlled (140-160/90-100 mm Hg), and very poorly controlled (>160/100 mm Hg) groups according to their resting BP. The mean age[±standard error of the mean] of the patients was 68±13 years, and 885 (43.4%) were men. The prevalence of well-controlled hypertension (HTN) was 47.2%, poorly controlled HTN was 29.5%, and very poorly controlled HTN was 23.3%. Evidence of ischemia was seen in 19.8% and 19.3% of the well-controlled and poorly controlled groups, respectively. The very poorly controlled group had the lowest incidence of ischemia (14.3%) (P<.05) compared with the other two groups. Symptoms that mimic ischemic heart disease in hypertensive patients may be partly explained by poorly controlled BP. Quality of care might be improved by optimally controlling BP in patients with angina symptoms prior to ordering diagnostic testing associated with radiation exposure and cost.
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