Mechanism of angina pectoris in patients with systemic hypertension and normal epicardial coronary arteries by arteriogram

https://doi.org/10.1016/0002-9149(94)90678-5Get rights and content

Abstract

Patients with arterial hypertension frequently have angina pectoris despite a normal coronary angiogram. This angina pectoris syndrome often goes along with an impaired coronary vasodilator reserve. The aim of the study was to find out whether an impaired coronary flow reserve is associated with electrographic signs of transient myocardial ischemia. Forty-three hypertensive patients not taking cardiovascular medication were studied with 24-hour Holter monitoring. Coronary blood flow and resistance were measured before and after intravenous administration of dipyridamole (0.5 mg/kg body weight). Coronary reserve was determined as the relation of coronary resistance before and after dipyridamole. For control purposes 9 normotensive subjects were studied with the same protocol. Hypertensive patients with ST-segment depressions (n = 31) had a significantly impaired coronary reserve (2.3 ± 0.5) compared with normotensive subjects (4.9 ± 1.0, p <0.01). Coronary reserve in hypertensive patients without ST-segment depressions was only slightly impaired (4.0 ± 1.8). Arterial pressure and left ventricular mass did not differ between hypertensive patients with and without ST-segment depressions. Left ventricular mass had no effect on coronary reserve. It is concluded that neither left ventricular hypertrophy nor arterial pressure were determinants for ST-segment depressions. Consequently primary functional and structural alterations on the level of the microcirculation appear to be responsible for the occurrence of transient ischemic episodes in the Hotter electrocardiogram.

References (26)

  • B.E. Strauer

    Hypertensive Heart Disease

    (1980)
  • D. Opherk et al.

    Reduction of coronary reserve: a mechanism for angina pectoris in patients with arterial hypertension and normal coronary arteries

    Circulation

    (1984)
  • L.Th. Sheffield

    Exercise stress testing

  • Cited by (92)

    • Increased morning blood pressure surge and coronary microvascular dysfunction in patient with early stage hypertension

      2014, Journal of the American Society of Hypertension
      Citation Excerpt :

      Hypertensive patients may have symptoms and signs of myocardial ischemia related to impaired microvascular function despite angiographically normal epicardial coronary arteries.23 Arterial structural changes in hypertension are not only an adaptation to the high BP, but also the result of an early hypertension-related change in the resistance arteries, leading to an exaggerated impairment of artery structure and causing impaired organ perfusion in excess to that expected from the level of BP elevation.23–25 The vascular structural change that is disproportional to BP elevation might be related to MBPS.

    • From Hypertension to Heart Failure: Role of Nitric Oxide-Mediated Endothelial Dysfunction and Emerging Insights from Myocardial Contrast Echocardiography

      2007, American Journal of Cardiology
      Citation Excerpt :

      African Americans have a high prevalence of risk factors and have worse outcomes from CAD, despite less obstructive coronary atherosclerosis, than whites. Some investigators have therefore suggested that an underlying microvascular dysfunction may contribute to the poor cardiovascular outcome of CAD in African Americans.16 Although much of the extrapolation of the role of the microvasculature on target organ damage in hypertension has been derived from animal studies,17 there is growing evidence that African Americans have more endothelial dysfunction than do non–African Americans.2,18,19

    • Hypertensive Heart Disease

      2007, Comprehensive Hypertension
    View all citing articles on Scopus

    This study was supported by Grant SFB242 from the Deutsche Forschungsgemeinschaft, Bonn, Germany.

    View full text