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Correction of left ventricular ischemia in blacks with hypertensive heart disease
A A Carr1, L M Prisant, J L Houghton
1Department of Medicine, Medical College of Georgia, Augusta 30912-3150.
Insights
Intensive antihypertensive therapy, including calcium antagonists and ACE inhibitors, can reverse myocardial ischemia in black patients with hypertensive heart disease. This treatment may improve coronary blood flow regulation, independent of left ventricular mass reduction.
Area of Science:
- Cardiology
- Hypertension Research
- Medical Imaging
Background:
- Black hypertensive patients exhibit higher rates of ischemia compared to white patients.
- Potential racial disparities in coronary blood flow regulation may contribute to this difference.
Purpose of the Study:
- To investigate if intensive antihypertensive therapy can reduce or reverse myocardial ischemia in black hypertensive patients.
- To explore the role of left ventricular mass reduction and coronary blood flow regulation in treatment effectiveness.
Main Methods:
- 13 black patients with essential hypertension and ischemic heart disease underwent thallium myocardial stress imaging, electrocardiography, and echocardiography.
- Patients received intensive therapy with a calcium antagonist and an angiotensin converting enzyme (ACE) inhibitor for 4-48 months.
- Studies were conducted at baseline and after treatment to assess changes.
Main Results:
- The majority of patients showed abolition or reversal of myocardial ischemia.
- Significant reduction in left ventricular mass (LVM) was observed in most patients with reversed ischemia.
- Some patients experienced ischemia reversal without significant LVM changes, suggesting other factors like improved coronary blood flow regulation.
Conclusions:
- Intensive antihypertensive therapy is effective in reversing myocardial ischemia in black hypertensive patients.
- Both LVM reduction and improved coronary blood flow regulation appear to be key factors in treatment efficacy.
- Electrocardiography and thallium imaging can serve as indicators for assessing treatment effectiveness.
Abstract:
Among hypertensive patients, blacks are more likely than whites to have ischemia by electrocardiographic and 201Tl-myocardial stress imaging, possibly due to racial differences in the regulation of coronary blood flow or velocity. This investigation was undertaken to determine whether intensive antihypertensive therapy with two or more drugs can correct or reduce ischemia in black hypertensive patients. Thallium myocardial stress imaging and electrocardiographic and echocardiographic studies were performed on 13 black patients with essential hypertension and ischemic heart disease due to hypertensive heart disease (without significant obstructive epicardial coronary artery disease). The studies were made at baseline and after 4 to 48 months of intensive treatment, with a calcium antagonist and an angiotensin converting enzyme (ACE) inhibitor as the main components of the antihypertensive drug regimen. The majority of the patients with abolition or reversal of myocardial ischemia documented by 201Tl-myocardial imaging also had a significant reduction in left ventricular mass (LVM). However, some patients either did not have LV hypertrophy at baseline or had changes in LVM beyond the precision of the echocardiographic M-mode mass calculations. The finding indicated that factors other than reduction of LVM were involved in the reversal of the ischemia. The most likely factor was a change in the regulation of coronary blood flow. Reduction in LVM and reversal of myocardial ischemia determined either by electrocardiography or by thallium myocardial imaging studies may be considered indicators of the effectiveness of treatment.