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(Hypertension. 2001;37:1083.)
© 2001 American Heart Association, Inc.

Scientific Contributions

Silent ST Depression and Cardiovascular End-Organ Damage in Newly Found, Older Hypertensives

Presented in part at the Fourteenth Scientific Meeting of the American Society of Hypertension, New York, NY, May 1999.

Willem F. Terpstra; Johan F. May; Andries J. Smit; Pieter A. de Graeff; Frits H. Schuurman; Betty Meyboom-de Jong; Harry J. G. M. Crijns

From the Department of Cardiology/Thoraxcenter (W.F.T., J.F.M., H.J.G.M.C.), the Department of Internal Medicine (A.J.S., P.A.d.G.), and the Department of General Practice (B.M.-d.J.), University Hospital Groningen; and Groningen Hypertension Service (J.F.M., A.J.S., P.A.d.G., F.H.S., B.M.-d.J.), Groningen, The Netherlands.

Correspondence to W.F. Terpstra, MD, Department of Cardiology/Thoraxcenter, University Hospital Groningen, Hanzeplein 1, PO Box 30.001, 9713 GZ Groningen, The Netherlands. E-mail w.f.terpstra{at}castel.nl

Abstract—In hypertension, both reduced vascular supply and increased cardiac demand contribute to the development of (silent) myocardial ischemia. Our aim was to determine the prevalence of ST-segment depression and to analyze contributing factors in asymptomatic, previously untreated, older hypertensives. From a population survey, in 184 patients with mild hypertension (4 times systolic blood pressure 160 mm Hg and/or diastolic blood pressure 95 mm Hg), 60 to 75 years of age, cardiovascular end-organ damage was measured. Episodes of ST-segment depression were measured by 48-hour ambulatory Holter monitoring and were observed in 21 hypertensives (12%). They showed a significantly higher combined far-wall intima-media thickness of carotid and femoral arteries and more arterial plaques as measured by B-mode ultrasound compared with hypertensives without ST depression (0.00098±0.00021 versus 0.00088±0.00016 mm and 5.2±3.7 versus 3.7±2.8 plaques, P<0.05, respectively), whereas left ventricular mass index was not different (111±18 versus 104±24 g/m²; P=0.18, respectively). In hypertensives with transient ST-segment depression, a significant relation was found between left ventricular mass and ischemic burden (r=0.51, P=0.02). Approximately 1 of 8 unselected and previously untreated older hypertensives show asymptomatic ST-segment depression, suggestive of silent myocardial ischemia. These data suggest that vascular factors mainly determine the occurrence of ischemic ST-segment depression and cardiac factors determine the ischemic burden in older hypertensives.

Key Words: ischemia • hypertrophy, left ventricular • ventricular function, left • elderly • hypertension, secondary

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