USEFULNESS OF SIMULTANEOUS AMBULATORY ELECTROCARDIOGRAPHIC AND BLOOD-PRESSURE MONITORING IN DETECTING MYOCARDIAL-ISCHEMIA IN PATIENTS GREATER-THAN-70 YEARS OF AGE WITH SYSTEMIC HYPERTENSION

Ischemic-type ST-segment depression is frequently observed in younger hypertensive patients. To assess the frequency of ST-segment depressio n in elderly hypertensive patients and to determine the influence of h eart rate (HR) and blood pressure (BP) on the episodes of transient my ocardial ischemia, ambulatory electrocardiographic and BP monitoring w as simultaneously performed in 41 untreated hypertensive patients >70 years of age (mean age 79 +/- 6 years; office BP greater-than-or-equal -to 160/95 mm Hg). A total of 66 episodes of significant ST-segment de pression (greater-than-or-equal-to 0.1 mV, duration greater-than-or-eq ual-to 1 minute, interval greater-than-or-equal-to 1 minute) could be demonstrated ir) 15 patients (37%); 26 patients (63%) had no ST-segmen t changes. The 2 groups did not differ in age, gender, office or ambul atory BP, diurnal BP profile, concomitant diseases, ventricular arrhyt hmias, or in left ventricular (LV) mass or function. In 11 patients wi th ST-segment depression (73%), an increase in HR of >15% preceded the episodes of ST-segment depression; 2 of these patients (13%) had an a dditional increase in BP of >20/10 mm Hg. The extent of ST-segment dep ression was correlated significantly to BP, HR and HR X systolic BP pr oduct during the ischemic events, to office BP, and to LV mass. In con clusion, transient myocardial ischemia is a frequent phenomenon in eld erly hypertensive patients with and without LV hypertrophy. Whereas mo st episodes of ischemia are preceded by an increase in HR, the extent of ST-segment depression is dependent on HR, BP and LV mass.