[Myocardial ischemia in hypertensive patients--pathogenesis, prevalence and prognosis]. / Myokardischämien bei Hypertonikern--Pathogenese, Prävalenz und Prognose.

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.

[Myocardial ischemia in hypertensive patients]. / Myokardischämien bei Hypertonikern.

AIM: To examine the frequency of myocardial ischemia in hypertensive patients with insufficiently adjusted blood pressure. It was to clarify the question if there is a difference between hypertensives with silent ischemic episodes alone and hypertensives with symptomatic episodes as well, referring to the degree of severity of ischemia. A resulting question was: if there is a difference between them, might it be possible to influence this by lowering the blood pressure? PATIENTS AND METHODS: 104 hypertensive 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. RESULTS: 38 of the examined hypertensives showed 316 silent and 19 symptomatic episodes of myocardial ischemia. Hypertensives with additionally symptomatic episodes (n = 8) showed a severity of ischemia (ST-total area) which was significantly higher than in patients with only silent episodes (9.3 [2.7-65.3] mV min vs 2.6 [0.1-42.6] mV min, p < 0.05). After reduction of the blood pressure these patients as well as patients with silent episodes a lone (2.6 [0.1-42.6] mV min vs 0 [0 to 39.3] mV min, p < 0.0001) were found to have a decline of the ST-total area (9.3 [2.7-65.3] mV min vs. 0 [0-46.5] mV min, p < 0.05). There was no significant difference between them any longer. CONCLUSION: The severity of ischemia in insufficiently adjusted hypertensive patients with additionally symptomatic myocardial ischemia is higher than in the case of patients with silent episodes alone. After reaching a normotensive blood pressure again a difference was no longer evident.