title: Silent ST depression and cardiovascular end-organ damage in newly found, older hypertensives.
abstract: In hypertension, both reduced vascular supply and increased cardiac demand contribute to the development of (silent) myocardial ischemia. Our aim was to determine the prevalence of ST-segment depression and to analyze contributing factors in asymptomatic, previously untreated, older hypertensives. From a population survey, in 184 patients with mild hypertension (4 times systolic blood pressure >/=160 mm Hg and/or diastolic blood pressure >/=95 mm Hg), 60 to 75 years of age, cardiovascular end-organ damage was measured. Episodes of ST-segment depression were measured by 48-hour ambulatory Holter monitoring and were observed in 21 hypertensives (12%). They showed a significantly higher combined far-wall intima-media thickness of carotid and femoral arteries and more arterial plaques as measured by B-mode ultrasound compared with hypertensives without ST depression (0.00098+/-0.00021 versus 0.00088+/-0.00016 mm and 5.2+/-3.7 versus 3.7+/-2.8 plaques, P<0.05, respectively), whereas left ventricular mass index was not different (111+/-18 versus 104+/-24 g/m(2); P=0.18, respectively). In hypertensives with transient ST-segment depression, a significant relation was found between left ventricular mass and ischemic burden (r=0.51, P=0.02). Approximately 1 of 8 unselected and previously untreated older hypertensives show asymptomatic ST-segment depression, suggestive of silent myocardial ischemia. These data suggest that vascular factors mainly determine the occurrence of ischemic ST-segment depression and cardiac factors determine the ischemic burden in older hypertensives.
authors: Department of Cardiology/Thoraxcenter, University Hospital Groningen, The Netherlands. w.f.terpstra@castel.nl.
authors: W F
authors: WF
authors: Terpstra
authors: J F
authors: JF
authors: May
authors: A J
authors: AJ
authors: Smit
authors: P A
authors: PA
authors: de Graeff
authors: F H
authors: FH
authors: Schuurman
authors: B
authors: B
authors: Meyboom-de Jong
authors: H J
authors: HJ
authors: Crijns
mesh_terms: D000368:Aged; D001161:Arteriosclerosis / Q000473:pathology; D002339:Carotid Arteries / Q000473:pathology; D002940:Circadian Rhythm; D004452:Echocardiography; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D005263:Femoral Artery / Q000473:pathology; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology*; D012044:Regression Analysis