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Type: Artigo de periódico
Title: Predictors Of Silent Myocardial Ischemia In Resistant Hypertensive Patients.
Author: Modolo, Rodrigo
de Faria, Ana Paula
Paganelli, Maria O
Sabbatini, Andréa R
Barbaro, Natália R
Nascimento, Beatriz B
Ramos, Celso D
Fontana, Vanessa
Calhoun, David A
Moreno, Heitor
Abstract: 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. 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. 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. 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.
Subject: Blood Pressure
Coronary Artery Disease
Myocardial Ischemia
Resistant Hypertension
Target Organ Damage.
Citation: American Journal Of Hypertension. v. 28, n. 2, p. 200-7, 2015-Feb.
Rights: fechado
Identifier DOI: 10.1093/ajh/hpu140
Date Issue: 2015
Appears in Collections:Unicamp - Artigos e Outros Documentos

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