Silent myocardial ischemia in patients with essential hypertension.
The aim of this study was to determine the significance of the "coronary factor" in patients with essential hypertension (EH). Electrocardiogram Holter monitoring was performed in 61 patients with EH stage II (according to the World Health Organization criteria). Silent, ie, painless ST-segment depression, was found in 34 patients on whom echocardiography, a treadmill test, and transesophageal pacing were performed. In 21 patients with EH and silent ischemia, the examination included 201Tl stress scintigraphy, coronary angiography, and a platelet aggregation test. In 15 patients, catecholamines and beta-endorphins were obtained in blood samples during silent ischemia. 201Tl scintigraphy showed transient defects of perfusion without clearance abnormalities (group I) and with clearance abnormalities (group II). The patients in group I had more severe left ventricular hypertrophy (LVH) and a significantly higher platelet aggregation response to 0.5 mumol/L adenosine diphosphate; one patient in this group had coronary atherosclerosis. LVH and the platelet aggregation response was less pronounced in the patients in group II, but atherosclerotic lesions of a coronary artery were observed in four patients. In both groups, norepinephrine and beta-endorphin levels were increased during silent episodes of ischemia. The results suggest that there are different pathogenetic mechanisms of coronary insufficiency in patients with EH, a hypertensive heart, and silent ischemia.
Yurenev
A P
AP
Institute of Clinical Cardiology, Russian Academy of Medical Sciences of the USSR, Moscow.
DeQuattro
V
V
Dubov
P B
PB
Ostroumov
E N
EN
Nikulin
I A
IA
Konyaeva
E B
EB
Balyakina
E V
EV
Atachanov
S E
SE
Kosenko
A I
AI
Popov
E G
EG
D000328:Adult; D002304:Cardiac Pacing, Artificial; D002395:Catecholamines / Q000097:blood; D017023:Coronary Angiography; D003327:Coronary Disease / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D004452:Echocardiography; D004947:Esophagus / Q000502:physiology; D005080:Exercise Test; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010974:Platelet Aggregation; D011877:Radionuclide Imaging; D001615:beta-Endorphin / Q000097:blood
D002395:Catecholamines; D001615:beta-Endorphin