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Systemic hypertension, left ventricular hypertrophy and coronary artery disease

J F Tubau1, J Szlachcic, M J London

  • 1Division of Cardiology, Veterans Administration Medical Center, San Francisco California 94121.

The American Journal of Cardiology
|December 14, 1987
PubMed

Insights

Hypertensive left ventricular hypertrophy increases coronary artery disease (CAD) risk. Early detection of silent CAD in these patients is crucial for effective antihypertensive treatment and reduced mortality.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Vascular Medicine

Background:

  • Hypertensive left ventricular hypertrophy (LVH) is linked to reduced coronary vascular reserve and accelerated atherosclerosis.
  • This contributes to increased coronary morbidity and mortality in hypertensive individuals with LVH.
  • Previous antihypertensive trials have shown limited success in reducing coronary outcomes, highlighting unmet needs.

Purpose of the Study:

  • To emphasize the importance of early detection of coronary artery disease (CAD) in hypertensive patients with LVH.
  • To discuss a strategy for detecting asymptomatic CAD using combined noninvasive tests.
  • To assess the impact of silent ischemia on coronary mortality in antihypertensive trials.

Main Methods:

  • Analysis of coronary circulation changes in hypertensive LVH.
  • Review of epidemiologic findings on coronary morbidity and mortality.
  • Evaluation of a diagnostic strategy combining two noninvasive tests for CAD detection.
  • Follow-up of patients with abnormal exercise test results.

Main Results:

  • Hypertensive LVH patients showed a 20-30% incidence of abnormal exercise test results.
  • Positive exercise tests predicted typical angina development within 3 years.
  • Silent ischemia may account for up to 40% of coronary mortality in prior trials.

Conclusions:

  • Early detection of asymptomatic CAD in hypertensive patients with LVH is critical.
  • Separate follow-up of patients with silent CAD is needed.
  • This approach may better elucidate the effects of antihypertensive treatments on coronary outcomes.

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