title: Risk factors for silent myocardial ischemia in patients with well-controlled essential hypertension.
abstract: Silent myocardial ischemia (SMI) is frequently observed in patients with essential hypertension (EH). The major risk factor for SMI is uncontrolled blood pressure (BP), but SMI is also observed in patients with well-controlled BP. To evaluate the prevalence of SMI and the factors associated with SMI in EH patients with well-controlled BP. The medical records of 859 EH patients who underwent simultaneous 24-h ambulatory blood pressure monitoring (ABPM) and 24-h ambulatory electrocardiogram recording (AECG) were retrospectively evaluated. Each SMI episode was characterized by: (a) ST segment depression ≥0.5 mm; (b) duration of ST segment depression >60 s; and (c) reversibility of the ST segment depression. Overall 126 EH patients (14.7 %) had at least one episode of SMI. The SMI events were more frequent among patients with poorly controlled compared to those with well-controlled BP [86/479 (17.95 %) vs. 40/380 (10.52 %), p < 0.01]. Among EH patients with well-controlled BP, current and past smoking as well as the presence of an additional metabolic syndrome (MetS) constitutive element (obesity, impaired fasting glucose level or dyslipidemia) were significantly associated with the occurrence of SMI. In all EH patients with well-controlled BP and AECG evidence of SMI, there were one or more coronary artery stenotic lesions greater than 50 % found at coronary angiography. In EH patients who are current smokers, or have one or more additional components of a MetS there is markedly reduced benefit associated with good BP control with regard to the occurrence of myocardial ischemia: in this patient category, an AECG may help detect this condition.
authors: Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, 80131, Naples, Italy. domenico.rendina@unina.it.|Spinelli Hospital, Belvedere Marittimo, Cosenza, Italy. domenico.rendina@unina.it.
authors: Domenico
authors: http://orcid.org/0000-0002-0331-0392
authors: D
authors: Rendina
authors: Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, 80131, Naples, Italy.
authors: Renato
authors: R
authors: Ippolito
authors: Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, 80131, Naples, Italy.|Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Unité Diabète-Hypertension-Nutrition de l'Adolescent, Le Kremlin-Bicêtre, France.
authors: Gianpaolo
authors: G
authors: De Filippo
authors: Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, 80131, Naples, Italy.
authors: Riccardo
authors: R
authors: Muscariello
authors: Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, 80131, Naples, Italy.
authors: Daniela
authors: D
authors: De Palma
authors: Spinelli Hospital, Belvedere Marittimo, Cosenza, Italy.|Cardiology Unit, Ferrari Hospital, Castrovillari, Cosenza, Italy.
authors: Silvana
authors: S
authors: De Bonis
authors: Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, 80131, Naples, Italy.
authors: Michele
authors: M
authors: Schiano di Cola
authors: Spinelli Hospital, Belvedere Marittimo, Cosenza, Italy.
authors: Domenico
authors: D
authors: Benvenuto
authors: Department of Advanced Clinical Sciences, Federico II University, Naples, Italy.
authors: Maurizio
authors: M
authors: Galderisi
authors: Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, 80131, Naples, Italy.
authors: Pasquale
authors: P
authors: Strazzullo
authors: Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, 80131, Naples, Italy.
authors: Ferruccio
authors: F
authors: Galletti
mesh_terms: D058070:Asymptomatic Diseases; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology / Q000517:prevention & control*; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000209:etiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
keywords: 24-h ambulatory blood pressure monitoring; 24-h ambulatory electrocardiogram; Asymptomatic coronary artery disease; Blood pressure control