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Prevalence and circadian variations of ST-segment depression and its concomitant blood pressure changes in
R Asmar1, A Benetos, B Pannier
1Department of Internal Medicine, Institut National de la Santé et de la Recherche Médicale, Boussais Hospital, Paris, France.
Insights
Hypertension patients often experience silent ischemia, indicated by ST-segment depression episodes. Elevated blood pressure (BP) and stress are linked to these events, highlighting the need for comprehensive monitoring.
Area of Science:
- Cardiology
- Hypertension Research
- Diagnostic Monitoring
Background:
- Coronary artery disease is a significant complication of hypertension.
- Silent ischemia, a manifestation of coronary artery disease, poses diagnostic challenges.
- Understanding the relationship between hypertension, blood pressure variations, and ischemic events is crucial.
Purpose of the Study:
- To determine the prevalence and circadian patterns of ST-segment depression in hypertensive patients.
- To investigate the association between ST-segment depression and concurrent blood pressure (BP) and heart rate variations.
- To identify potential triggers and associated risk factors for silent ischemia in hypertension.
Main Methods:
- One hundred hypertensive patients underwent 24-hour ambulatory monitoring.
- Simultaneous Holter electrocardiogram and intermittent noninvasive BP measurements were recorded.
- Extra BP measurements were triggered by ST depression detection (>1 mm and >60 seconds).
Main Results:
- ST-segment depression episodes were observed in 23% of patients (23 out of 100).
- Higher ambulatory BP load (systolic and diastolic) was noted in patients with ST depression.
- Episodes peaked upon awakening and in the late afternoon; elevated BP during episodes was observed.
Conclusions:
- Ambulatory monitoring reveals significant ST-segment depression in a notable percentage of hypertensive individuals.
- Elevated blood pressure load and variations appear to be key triggers for ST-segment depression in this population.
- These findings underscore the importance of continuous BP monitoring in managing hypertensive patients at risk for silent ischemia.
Abstract:
Coronary artery disease is a major complication of hypertension; one of its manifestations is silent ischemia. The aim of this study was to assess the prevalence and circadian distribution of ST-segment depression together with concomitant blood pressure (BP) and heart rate variations. One hundred patients (male:female ratio 1:1) with a mean age (+/- SD) of 51 +/- 8 years underwent ambulatory monitoring using the combined AMP 5600 monitor which simultaneously records a continuous Holter electrocardiogram and intermittent noninvasive BP measurements at 15-minute intervals, with extra measurements triggered by detection of a horizontal or downsloping ST depression (> 1 mm and >60 seconds). Cardiovascular risk factors were fully evaluated in all patients; accurate and reliable echocardiogram enabled left ventricular mass index to be calculated in 52 patients. Twenty-three patients (15 men and 8 women) experienced a total of 72 episodes of ST depression. Duration of such episodes (mean +/- SD) was 132 +/- 65 seconds and amplitude was 1.51 +/- 0.55 mm. Circadian distribution showed 2 peaks: on awakening and in the late afternoon periods. The mean ambulatory BP load was greater in the patients with than without ST-segment depression for both systolic and diastolic BP (135 +/- 14 vs 129 +/- 15 and 84 +/- 8 vs 79 +/- 10 mm Hg, respectively; p < 0.01). Plasma glucose (5.83 +/- 0.70 vs 5.46 +/- 0.71 mmol/L; p = 0.04) and self-related work-related stress levels (22% vs 13%; p = 0.03) were also higher in patients with ST-segment depression. There were no significant differences between groups for clinical parameters, left ventricular mass index, and other cardiovascular risk factors. During ST depression episodes, systolic BP increased by 9 +/- 15 mm Hg, diastolic BP by 7 +/- 11 mm Hg, and heart rate by 5 +/- 17 beats/min. Thus, 24-hour Holter electrocardiographic monitoring showed ST depression episodes in 23 of 100 hypertensive patients (23%); ambulatory BP load was greater in these patients. BP variations, and mainly its elevation, may trigger such episodes of ST-segment depression.