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[Clinical and coronary angiographic characteristics of hypertensive angina]
Insights
This study found a specific type of chest pain (angor pectoris) in hypertensive patients linked to left ventricular hypertrophy, not coronary artery stenosis. This suggests a distinct management approach is needed for these patients.
Area of Science:
- Cardiology
- Internal Medicine
- Hypertension Research
Background:
- Systemic hypertension is a major cardiovascular risk factor.
- Angor pectoris in hypertensive patients can have varied etiologies.
- Left ventricular hypertrophy (LVH) is a common complication of hypertension.
Purpose of the Study:
- To investigate the relationship between angor pectoris, left ventricular hypertrophy, and coronary artery disease in hypertensive patients.
- To differentiate angor pectoris subtypes in hypertension based on clinical and diagnostic findings.
- To inform tailored management strategies for hypertensive patients experiencing chest pain.
Main Methods:
- Study included 46 hypertensive patients categorized into three groups: angor pectoris (Group I), LVH (Group II), and controls (Group III).
- All patients underwent clinical evaluation, exercise electrocardiography, coronary angiography, and cineventriculography.
- Demographic, clinical characteristics, pain patterns, and diagnostic test results were analyzed.
Main Results:
- Group I (angor pectoris) showed significant S-T segment depression (95.2%) and positive exercise tests (86.6%), but only 28% had coronary stenosis; 94.8% had vessel tortuosity.
- Group II (LVH) exhibited S-T depression (75%) and positive exercise tests (50%), with no coronary stenosis but vessel tortuosity in 74.9%.
- Group III (controls) had no S-T depression and a lower rate of positive exercise tests (20%) and vessel tortuosity (69.1%).
Conclusions:
- A distinct form of angor pectoris exists in hypertensive individuals, associated with left ventricular hypertrophy rather than coronary artery stenosis.
- Vessel tortuosity is prevalent across all groups, but coronary stenosis is not the primary cause of angor pectoris in this context.
- Management protocols for hypertensive patients with angor pectoris and LVH should differ from standard approaches for coronary artery disease.
Abstract:
The sample studied consisted of 46 patients with systemic hypertension. Of these, 21 had angor pectoris and constituted group I; 12 showed left ventricular hypertrophy, constituting group II; the other 13 subjects did not have complications and they formed group III. All patients, aside from the usual clinical evaluation, were submitted to exercise electrocardiography, coronary angiography and cineventriculography. The average age of patients in group III was lower than in the others (38.6 +/- 8.4 years), and so was the percentage of smokers (15.3%), and of patients with diabetes (23.0%). The number of smokers in group II represented 41.3% and in group I, 38%. The percentage of patients with diabetes was 33.3% in group II and 52.3% in group I. Pain in the patients of group I had the following characteristics: retrosternal pain was present in all cases, while referred pain to the neck and left arm appeared in 61% of the subjects. In 66.3% of the individuals the pain lasted between 5 and 15 minutes. In 52.3% of the group, pain was not always related to effort, but appeared also at rest. Temporal periodicity was present in 52.7% of the patients. Also in group I, 95.2% of the cases had a depression of the S-T segment in the leads corresponding to the anterior aspect of the left ventricle. In 86.6% of the subjects, there was a positive exercise test. The Sokoloff's index was 26.4 +/- 7.9 mm. In 75% of the subjects in group II, a depression of the S-T segment was present, and a positive exercise test was found in 50% of them. Their sokoloff's index was 26.7 +/- 6.4. None of the patients in group III had depressions of the S-T segment and 20% resulted with a positive exercise test. Their sokoloff's index was 13.3 +/- 2.9. The coronary angiography results showed stenosis in 28% of the subjects in group I and tortuosity of the vessels was apparent in 94.8% of them. None of the patients of group II and III had stenosis of the coronaries, but tortuosity was observed in 74.9% of the individuals in group II and in 69.1% of the cases in group III. Based in these data we conclude that there is a type of angor pectoris in hypertensive subjects which is related to hypertrophy of the left ventricle, but not to coronary stenosis. The management of this type of patient should be different to the regular one.