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Silent myocardial ischaemia in untreated essential hypertensives
A P Schroeder1, B Brysting, P Søgaard
1Department of Internal Medicine, Viborg Hospital, Denmark.
Insights
Silent ischaemia is common in untreated hypertension, detected by Holter monitoring. Higher blood pressure and left ventricular mass may be associated with this silent ischaemia.
Area of Science:
- Cardiology
- Hypertension Research
- Ischaemia Studies
Background:
- Left ventricular hypertrophy in hypertension can increase oxygen demand, potentially leading to ischaemia.
- Understanding silent ischaemia prevalence is crucial for managing hypertensive patients.
Purpose of the Study:
- To determine the prevalence of silent ischaemia in untreated hypertensive individuals.
- To investigate associations between ischaemia, blood pressure, and left ventricular mass.
Main Methods:
- Utilized Holter monitoring and three stress tests (bicycle ergometer, hyperventilation, captopril) in 34 untreated hypertensive patients.
- Assessed prevalence of silent ischaemic periods and correlated findings with blood pressure levels and left ventricular mass.
Main Results:
- Holter monitoring revealed silent ischaemia in 68% of patients.
- Significant trends observed towards higher 24-hour systolic and diastolic blood pressure, catecholamine excretion, and left ventricular mass in patients with ischaemia.
- Stress tests showed lower ischaemia prevalence: 27% (ergometer), 3% (hyperventilation, captopril).
Conclusions:
- Holter monitoring is effective in detecting silent ischaemia in a significant portion of untreated hypertensive patients.
- Ischaemia prevalence was low with specific stress tests, contrasting with Holter findings.
- Hypertensive patients with ischaemia tended to exhibit more severe hypertension.
Abstract:
In hypertension, hypertrophy of the left ventricle might enhance the risk of ischaemia because of an augmented oxygen demand and an insufficient oxygen supply. The aims of the study were to estimate the prevalence of silent ischaemia in a group of untreated hypertensives with Holter monitoring and 3 different stress tests, and to look for a possible association between the presence of ischaemia and the blood pressure level as well as the left ventricular mass. The prevalence of silent ischaemia was tested in a group of 34 untreated hypertensives by Holter monitoring and by bicycle ergometer test, hyperventilation and captopril tests. 68% of the patients exhibited silent ischaemic periods during Holter monitoring. There was a trend towards a higher 24-hour SBP and DBP level in patients with ischaemia (p < 0.05), in addition to a tendency towards a higher catecholamine excretion in patients with ischaemia (p < 0.05), and a higher left ventricular mass (NS). Silent ischaemic episodes during ergometer exercise test were found in 27%. Only 3% had ischaemia during hyperventilation and captopril tests. In conclusion, the prevalence of ischaemia during the various stress tests was low, whereas Holter monitoring revealed signs of silent ischaemia in a substantial proportion of the patients. Patients with ischaemia tended to present more severe degrees of hypertension.