title: Predictors of silent myocardial ischemia in resistant hypertensive patients.
abstract: BACKGROUND
  Hypertension is the most prevalent and significant modifiable risk factor for coronary heart disease. A portion of patients with uncontrolled hypertension are considered to have resistant hypertension (RHTN). Myocardial ischemia incidence increases along with blood pressure (BP) levels. However, the prevalence of myocardial ischemia in patients with RHTN, as well as the factors associated with it, is unknown.
  
  
  METHODS
  We enrolled 129 patients with true RHTN regularly followed in our specialty hypertension clinic and evaluated then by resting and dipyridamole pharmacological stress myocardial perfusion scintigraphy. Patients were then divided into 2 groups: those with (I-RHTN; n = 36) and those without (NI-RHTN; n = 93) myocardial ischemia. Echocardiography, 24-hour ambulatory BP monitoring (ABPM), and flow mediated dilation (FMD) were also evaluated.
  
  
  RESULTS
  Thirty six (28%) patients had myocardial ischemia. There was no difference between groups regarding age, sex, biochemical parameters, office, and 24-hour ABPM levels. Patients in the I-RHTN group were more likely diabetic (31% vs. 11%; P < 0.05) and obese (75% vs. 40%; P < 0.001). Adjusting for age and body mass index, multiple logistic regression showed that diabetes (odds ratio (OR) = 6.5; 95% confidence interval (CI) = 1.06-40.14; P = 0.04), FMD (OR = 0.18; 95% CI = 0.07-0.41; P < 0.001), heart rate (OR = 1.23; 95% CI = 1.11-1.36; P < 0.001), left ventricular mass index (OR = 1.02; 95% CI = 1.01-1.04; P = 0.04), and microalbuminuria (OR = 1.02; 95% CI = 1.01-1.04; P = 0.002) were independent predictors of ischemia.
  
  
  CONCLUSIONS
  In conclusion, there is a high prevalence of myocardial ischemia in patients with RHTN. Increased microalbuminuria, heart rate, endothelial dysfunction, and left ventricular mass can be useful to guide the investigation for myocardial ischemia in these high risk patients.
authors: Department of Pharmacology, Faculty of Medical Sciences University of Campinas-UNICAMP, Campinas, SP, Brazil; rodrigo_modolo@yahoo.com.br.
authors: Rodrigo
authors: R
authors: Modolo
authors: Department of Pharmacology, Faculty of Medical Sciences University of Campinas-UNICAMP, Campinas, SP, Brazil;
authors: Ana Paula
authors: AP
authors: de Faria
authors: Department of Pharmacology, Faculty of Medical Sciences University of Campinas-UNICAMP, Campinas, SP, Brazil;
authors: Maria O
authors: MO
authors: Paganelli
authors: Department of Pharmacology, Faculty of Medical Sciences University of Campinas-UNICAMP, Campinas, SP, Brazil;
authors: Andréa R
authors: AR
authors: Sabbatini
authors: Department of Pharmacology, Faculty of Medical Sciences University of Campinas-UNICAMP, Campinas, SP, Brazil;
authors: Natália R
authors: NR
authors: Barbaro
authors: Department of Radiology, Faculty of Medical Sciences, University of Campinas-UNICAMP, Campinas, SP, Brazil;
authors: Beatriz B
authors: BB
authors: Nascimento
authors: Department of Radiology, Faculty of Medical Sciences, University of Campinas-UNICAMP, Campinas, SP, Brazil;
authors: Celso D
authors: CD
authors: Ramos
authors: Department of Pharmacology, Faculty of Medical Sciences University of Campinas-UNICAMP, Campinas, SP, Brazil;
authors: Vanessa
authors: V
authors: Fontana
authors: Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, Alabama.
authors: David A
authors: DA
authors: Calhoun
authors: Department of Pharmacology, Faculty of Medical Sciences University of Campinas-UNICAMP, Campinas, SP, Brazil;
authors: Heitor
authors: H
authors: Moreno
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000453:epidemiology*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D058070:Asymptomatic Diseases; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004176:Dipyridamole; D004452:Echocardiography; D004730:Endothelium, Vascular / Q000503:physiopathology; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology*; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000453:epidemiology*; D055414:Myocardial Perfusion Imaging; D009765:Obesity / Q000453:epidemiology*; D012307:Risk Factors; D014664:Vasodilation; D014665:Vasodilator Agents
chemical_list: D000959:Antihypertensive Agents; D014665:Vasodilator Agents; D004176:Dipyridamole
keywords: blood pressure; coronary artery disease; hypertension; myocardial ischemia; resistant hypertension; target organ damage.