CORRECTION OF LEFT-VENTRICULAR ISCHEMIA IN BLACKS WITH HYPERTENSIVE HEART-DISEASE

Among hypertensive patients, blacks are more likely than whites to hav e ischemia by electrocardiographic and Tl-201-myocardial stress imagin g, possibly due to racial differences in the regulation of coronary bl ood flow or velocity. This investigation was undertaken to determine w hether intensive antihypertensive therapy with two or more drugs can c orrect or reduce ischemia in black hypertensive patients. Thallium myo cardial stress imaging and electrocardiographic and echocardiographic studies were performed on 13 black patients with essential hypertensio n and ischemic heart disease due to hypertensive heart disease (withou t significant obstructive epicardial coronary artery disease). The stu dies were made at baseline and after 4 to 48 months of intensive treat ment, with a calcium antagonist and an angiotensin converting enzyme ( ACE) inhibitor as the main components of the antihypertensive drug reg imen. The majority of the patients with abolition or reversal of myoca rdial ischemia documented by Tl-20-myocardial imaging also had a signi ficant reduction in left ventricular mass (LVM). However, some patient s either did not have LV hypertrophy at baseline or had changes in LVM beyond the precision of the echocardiographic M-mode mass calculation s. The finding indicated that factors other than reduction of LVM were involved in the reversal of the ischemia. The most likely factor was a change in the regulation of coronary blood flow. Reduction in LVM an d reversal of myocardial ischemia determined either by electrocardiogr aphy or by thallium myocardial imaging studies may be considered indic ators of the effectiveness of treatment.