Transient myocardial ischemia in hypertensive heart disease

Scheler, Sibylle; Motz, W.; Vester, Joanna; Strauer, Bodo E.

doi:10.1016/0002-9149(90)90960-9

Cited by 27 publications

(10 citation statements)

References 17 publications

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“…Such measurements would determine how many subjects there were with electro-or échocardiographie signs indicating cardiac left ventricular hypertro phy (LVH), which is an important predictor of cardiovascular morbidity and mortality [32][33][34], Up to 50% of elderly patients with essential hypertension can be found to have échocardiographie criteria of LVH [35]. How ever, several clinical studies have shown that many middle-aged and elderly hypertensive patients [36], even with normal left ventricu lar mass [15,37,38] or normal angiograms [14,38], have angina or episodes of asymp tomatic ST-segment depression during nor mal activity or various stresses, suggesting the presence of transient myocardial ischemia on the basis of an abnormal coronary flow re serve. Furthermore, in the study by Zehender et al [16] of 150 untreated, middle-aged hy pertensive patients, without manifest coro nary artery disease, the presence of electrocardiographically determined LVH and episodes of ST-segment depression (silent in 93%) on AEM were both independent predictors of a cardiac event during a 3-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…The Framingham Study has reported a high incidence of silent myocardial infarction in hypertensive patients [12]. Several clinical studies have demonstrated that hypertensives undergoing ambulatory ECG monitoring, even in the absence of large-vessel atheroscle rotic coronary artery disease, often have epi sodes of asymptomatic ischemic ST-segment depression during normal activity or various degrees of stress, suggesting the presence of silent myocardial ischemia [13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

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Hypertension and Silent Myocardial Ischemia: Their Influence on Cardiovascular Mortality and Morbidity

Hedblad¹,

Janzon²

1994

Cardiology

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The presence of ST-segment depression during ambulatory electrocardiographic monitoring, in relation to blood pressure treatment and control, was monitored in a non-randomized study in 167 men (49%) from the ‘Men born in 1914’ Malmö study, who were considered to have hypertension (diastolic blood pressure [DBP], ≧ 95 mm Hg or receiving antihypertensive therapy). Men were excluded if they had a history of ischemic heart disease. A high frequency of ST-segment depression (41%) and associated high cardiac event rate (14%) were found in hypertensive elderly men who had inadequately controlled blood pressure (i.e. DBP > 95 mm Hg). This was associated with a relative risk of a cardiac event of 9.8 (95% confidence interval: 2.6-36.9), even after adjustment for smoking, blood lipids and alcohol consumption. The lower frequency of ST-segment depression (21%) and lower cardiac event rate (5%) in hypertensive men with adequate blood pressure control suggests that effective antihypertensive treatment leads to a reduced event rate. In conclusion, the occurrence of ST-segment depression during ambulatory electrocardiographic monitoring in this group of subjects may be an expression of silent myocardial ischemia, with or without left ventricular hypertrophy. The incidence of asymptomatic ST-segment depression and the rate of cardiac events in hypertensive patients may be, in part, related to the level of blood pressure control attained.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hypertension and Silent Myocardial Ischemia: Their Influence on Cardiovascular Mortality and Morbidity

Hedblad¹,

Janzon²

1994

Cardiology

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“…As in a recent study of hypertensive patients with normal coronary arteries over 90% of these episodes were clinically silent. 26 There are several factors that may be responsible for myocardial ischaemia in hypertensive left ventricular hypertrophy. There is a transmural gradient of blood flow in left ventricular hypertrophy with reduced flow in the subendocardial layers27 that is accentuated by pac-ing28 and exercise.29 Although total myocardial blood flow is increased in left ventricular hypertrophy, the flow per 100 g is significantly reduced30 because of decreased coronary vascular reserve31 and perhaps disease of the small vessels.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic and silent myocardial ischaemia in hypertensive patients with left ventricular hypertrophy.

Pringle

Dunn

Tweddel

et al. 1992

Heart

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Objective-To assess the prevalence of symptomatic and silent myocardial ischaemia in patients with hypertensive left ventricular hypertrophy.Design-Cross sectional study. Setting-University department of medical cardiology.Patients-90 patients (68 men and 22 women; mean age 57 (range 25 to 79)) with left ventricular hypertrophy due to essential hypertension.Interventions-48 hour ambulatory ST segment monitoring (all patients), exercise electrocardiography (n = 79), stress thallium scintigraphy (n = 80), coronary arteriography (n = 35).Results-43 patients had at least one episode of ST segment depression on ambulatory electrocardiographic monitoring. The median number of episodes was 16 (range 1 to 84) with a median duration of 8-6 (range 2 to 17) min. Over 90% of these episodes were clinically silent. 26 patients had positive exercise electrocardiography and 48 patients had reversible thallium perfusion defects despite chest pain during exercise in only five patients. 18 of the 35 patients who had coronary arteriography had important coronary artery disease. Seven of these patients gave no history of chest pain.Conclusions-Symptomatic and silent myocardial ischaemia are common in hypertensive patients with left ventricular hypertrophy, even in the absence of epicardial coronary artery disease. Despite the large number of epidemiological studies there are few data on the objective assessment of myocardial ischaemia in individual patients with hypertensive left ventricular hypertrophy. We have shown previously that patients with hypertensive left ventricular hypertrophy may have thallium perfusion abnormalities or coronary artery disease and yet be symptom free.6 Because chest pain was an exclusion criterion for the previous study, however, the patients were not representative of all patients with hypertensive left ventricular hypertrophy. We therefore conducted the present study to assess prevalence of symptomatic and asymptomatic myocardial ischaemia in hypertensive patients with left ventricular hypertrophy attending a hospital based hypertension clinic and to determine the best non-invasive method to identify prognostically important coronary artery disease in these patients. Patients and methodsWe recruited 90 consecutive patients (68 men) (mean age 57 (range 25 to 79) years) who agreed to be in the study and fulfilled the following criteria:(a) they had essential hypertension-secondary hypertension was excluded by clinical evaluation, routine biochemical screening, chest x ray, and, where indicated, intravenous pyelography. (b) they had the electrocardiographic pattern of left ventricular hypertrophy and strain.

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“…Several risk factors have been related to silent ischemia, all well-established risk factors for overt CAD. [5][6][7]. and smoking?…”

Section: Introductionmentioning

confidence: 99%

Risk factors related to the occurrence of silent myocardial ischemia in mexicans

Unzueta‐Montoya¹,

Rubio²,

Unzueta³

et al. 2000

Clinical Cardiology

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s u m m a r yBackground: Silent myocardial ischemia is a growing world health problem. It has been related to factors that promote an increase in myocardial oxygen demand or affect coronary vasomotor tone. Coronary artery disease has shown an increasing trend in Mexico in this century.Hypothesis: The aim of the study was to estimate the strength of the association between some risk factors and the occurrence of silent myocardial ischemia.Methods: A cross-sectional study was conducted and 249 individuals were screened by 24-h Holter electrocardiogram. Silent myocardial ischemia was diagnosed in patients with painless transient ST-segment depression. All subjects were interviewed for coronary risk factors and total serum cholesterol was measured.Results: Silent ischemia was diagnosed in 115 patients (46%), who were older (59 k 9 vs. 57 f 1 1 years; p = 0.01). In a logistic regression analysis, a lower risk for silent ischemia was found in patients with thrombolysis [odds ratio (OR) 0.28; 95% confidence interval (CI 95%) 0.14-0.53], or those who followed their medical treatment (OR 0.16; CI 95% 0.04-0.68). The major risk factors were hypercholesterolemia (OR 1.6; CI 95% 0.9-2.9) and more severe coronary artery disease (OR 2.5; CI 95% 1.1-5.7). Conclusions: Some coronary risk factors are related to silent ischemia. It is still important to diagnose this entity, but modification of its related risk factors should be kept in mind to diminish its occurrence and its severe consequences.

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Transient myocardial ischemia in hypertensive heart disease

Cited by 27 publications

References 17 publications

Hypertension and Silent Myocardial Ischemia: Their Influence on Cardiovascular Mortality and Morbidity

Hypertension and Silent Myocardial Ischemia: Their Influence on Cardiovascular Mortality and Morbidity

Symptomatic and silent myocardial ischaemia in hypertensive patients with left ventricular hypertrophy.

Risk factors related to the occurrence of silent myocardial ischemia in mexicans

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