[Detection of silent ischemia in hypertensive subjects with high vascular risk using continuous electrocardiogram in real time].
To assess the prognostic value of ECG repolarisation abnormalities (negative T wave and/or ST downslopping (STD) less than 0.1 mV) in systemic hypertension, we compared the frequency of STD greater than or equal to 0.1 mV and greater than 40 s (Qmed real-time ambulatory ECG system) in asymptomatic high-risk hypertensive men with or without ST-T abnormalities on resting ECG (less than or equal to 0 T wave and less than 1 mm ST downslopping). Among 68 hypertensive patients in the upper quintile of risk distribution according to the Paris prospective study, 32 were R+ and 36 R-. Mean age (R+ 53, R- 53 yrs), blood pressure (R+ 180/106, R- 175/102 mmHg), body-mass index (R+ 27, R- 28 kg/m2) risk score (R+ 5.8, R- 5.4), and Sokolow index (R+ 2.7, R- 2.5 mV) were similar in both groups. Left ventricular mass index was different (R+ 152, R- 118 gr/m2, p less than 0.02). Mean recording duration was 35 hours. Eighty-nine episodes of STD were detected in 7 R+ patients (lasting 3 to 136 mn) and one R- patient (lasting 60 s), p less than 0.001. Echographic LVH was present in the 7 positive patients of the group R+. 6 patients underwent thallium scanning and/or coronary angiography: thallium was positive in 4 patients; coronary artery angiography was performed in 3 patients, showing bitroncular stenosis in 1 patient.


CONCLUSIONS
in the present group of high-risk asymptomatic hypertensive patients, the frequency of STD was higher (p = 0.05) in the presence of repolarisation abnormalities on the resting ECG. STD suggests silent ischemia and could account for the excess of cardio-vascular mortality connected with ST-T abnormalities in hypertension.
Nguyen
L D
LD
Service d'hypertension artérielle, hôpital Broussais, Paris, France.
Julien
J
J
Abir
S K
SK
Jeunemaître
X
X
Azizi
M
M
Plouin
P F
PF
Corvol
P
P
D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D004562:Electrocardiography; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D012307:Risk Factors
Détection de l'ischémie silencieuse chez des sujets hypertendus à haut risque vasculaire par électrocardiogramme continu en temps réel.