Hypertension and silent myocardial ischemia: their influence on cardiovascular mortality and morbidity.
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], > or = 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 > or = 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.
Hedblad
B
B
Department of Community Health Sciences, Lund University, Malmö General Hospital, Sweden.
Janzon
L
L
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality*; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D015994:Incidence; D008297:Male; D017202:Myocardial Ischemia / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires
D000959:Antihypertensive Agents