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The prevalence of silent myocardial ischaemia in patients with white-coat hypertension
I Nalbantgil1, R Onder, S Nalbantgil
1Ege University Medical School Cardiology Department, Izmir, Turkey.
Insights
White-coat hypertension (WCH) is not benign, with silent myocardial ischemia incidence significantly higher than in normal blood pressure groups. This study highlights WCH shares characteristics with essential hypertension, impacting cardiac health.
Area of Science:
- Cardiology
- Hypertension Research
Background:
- Silent myocardial ischemia (SMI) is a significant concern in cardiovascular health.
- White-coat hypertension (WCH) is characterized by elevated blood pressure in clinical settings but normal readings outside.
- The incidence of SMI in WCH patients compared to hypertensive and normotensive individuals requires further investigation.
Purpose of the Study:
- To estimate and compare the incidence of silent myocardial ischemia.
- To assess patients with mild to moderate hypertension, white-coat hypertension (WCH), and normal blood pressure.
- To determine if WCH presents a similar risk profile to essential hypertension regarding SMI.
Main Methods:
- Ambulatory electrocardiographic (ECG) monitoring was performed on 542 patients (272 normal BP, 164 hypertension, 106 WCH).
- Patients were aged 42-61 years, with no significant differences in age or gender across groups.
- Silent ischemia diagnosis required ST depression >2 mm for at least 120 sec on ambulatory ECG without anginal symptoms.
Main Results:
- The incidence of silent myocardial ischemia was 6.4% in normal blood pressure, 18.8% in WCH, and 26.2% in hypertension groups.
- Significant differences in SMI incidence were observed between the groups.
- No anginal symptoms or abnormal resting ECGs were noted in any participants.
Conclusions:
- White-coat hypertension is not a benign condition and is associated with a higher incidence of silent myocardial ischemia.
- WCH shares significant characteristics with essential hypertension, particularly concerning subclinical cardiac ischemia.
- These findings suggest closer monitoring and potential intervention for WCH patients to mitigate cardiovascular risk.
Abstract:
The aim of this study was to estimate the incidence of silent myocardial ischaemia in patients with mild to moderate hypertension, white-coat hypertension (WCH) and those with normal blood pressure. Ambulatory electrocardiographic (ECG) monitoring was carried out in 272 cases with normal blood pressure, 164 cases with mild to moderate hypertension (diastolic blood pressure >95 and <114 mm Hg), and 106 cases with white-coat hypertension who were diagnosed with ambulatory blood pressure monitoring. The ages of the patients of all groups were between 42-61 years. There were no differences between the groups according to age, gender and other parameters. There were no anginal symptoms, and resting ECGs were in normal limits in all cases. The diagnosis of silent ischaemia was considered to be present if there was ST depression >2 mm/at least 120 sec in ambulatory ECG examination without angina or its equivalent cardiac symptoms. The incidence of silent ischaemia was 6.4%, 18.8%, and 26.2% in cases with normal blood pressure, WCH, and hypertension, respectively. The differences between groups were significant. It was concluded that WCH is not a benign condition, but shares some characteristics with essential hypertension.