ST segment depression in hypertensive patients: a comparison of exercise test versus Holter ECG.
BACKGROUND
This study compared ST segment depression (ST depression) during cycle ergometry (ergometry) versus simultaneous 24-hour ambulatory blood pressure measurement and electrocardiogram recording (24-h ABPM/ECG) during everyday life.


METHODS
In a German multicenter study, ergometry and 24-h ABPM/ECG records of 239 hypertensive patients were retrospectively analyzed. ST depression was defined as an ST segment depression (1 mm limb or chest recordings V1 to V6) in an incremental cycle ergometry, or 1 mm in the 24-h ABPM/ECG recording under everyday conditions. Blood pressure parameters at the onset of ST depression in the context of the respective method were compared.


RESULTS
18 patients had ST depression only in ergometry (group B), 23 had ST depression only during 24-h ABPM/ECG monitoring (group C) and 28 patients had ST depression with both methods (group D). Group A had no ST depression with any method. In group D, at the onset of ST depression with 24-h ABPM/ECG investigation, all parameters except diastolic blood pressure were significantly lower compared with the corresponding parameters at the onset of ST depression with ergometry (systolic blood pressure: 148 +/- 19 vers 188 +/- 35 mmHg, p < 0.001; heart rate: 93 +/- 12 vs 120 +/- 21 beat/min, p < 0.0001; double product: 13,714 +/- 2315 vs 22,992 +/- 3,985 mmHg/min), p < 0.0001).


CONCLUSIONS
ST depressions during everyday life detected by 24-h ABPM/ECG are characterized by a substantially lower triggering threshold for blood pressure level parameters compared with ergometry. The two methods detecting ischemia do not replace but complement each other.
Uen
Sakir
S
Division of Hypertension and Vascular Medicine, Department of Internal Medicine II, University Clinic, Bonn, Germany. suen@uni-bonn.de
Fimmers
Rolf
R
Weisser
Burkhard
B
Baulmann
Johannes
J
Balta
Osman
O
Nickenig
Georg
G
Mengden
Thomas
T
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D005260:Female; D005858:Germany; D006329:Heart Conduction System / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies