[Myocardial ischemia in hypertensive patients--pathogenesis, prevalence and prognosis].
Arterial hypertension causes myocardial hypertrophy and affects coronary circulation through structural and functional changes of the coronaries. Therefore, the presence of arterial hypertension predisposes to atherosclerotic coronary artery disease. We examined the frequency of myocardial ischemia as well as their changing by means of medical blood pressure reduction in the case of 104 hypertensives with insufficiently adjusted blood pressure results. The patients had a check-up before and after the suspension of normotensive blood pressure by means of a 24-hour long-term ECG. Significant results for a myocardial ischemia were horizontal and descending ST-segment depression > or = 0.1 mV for the duration > or = 1 min. Before starting the treatment there were 38 patients with 335 ischemic episodes. The percentage of silent ischemic episodes was very high (94%). After lowering blood pressure 181.0 +/- 8.8 mmHg./98.7 +/- 9.7 mmHg vs. 136.4 +/- 11.5 mmHg./78.2 +/- 14.1 mmHg a reduction of the number of ischemic episodes (median 5 vs. 0, p < 0.0001) could be shown as well as a reduction in the ST-total area per patient (median 3.8 mV.min vs. 0 mV.min, p < 0.0001)--the decisive parameter for evaluation of the grade of the severity of ischemia. The danger of ischemic attacks respectively the total ischemic burden is reduced by antihypertensive drug treatment. This is important for the prognosis.
Hagert
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Klinik für Innere Medizin des Carl-von-Basedow-Klinikums Merseburg.
D000368:Aged; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D003430:Cross-Sectional Studies; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors