Myocardial perfusion abnormalities in treated hypertensive patients without known coronary artery disease

Objective Myocardial perfusion abnormalities may occur in hypertensive pati ents in absence of significant coronary artery disease. However, it is not well established whether hypertensive patients without known coronary arter y disease have a higher prevalence or extent of myocardial perfusion abnorm alities compared with normotensive patients with similar clinical features. Design This study compares the prevalence and extent of rest and stress-ind uced myocardial perfusion abnormalities in patients with and without hypert ension. Methods Dobutamine (up to 40 mu g/kg per min) stress technetium-gsm myocard ial perfusion SPECT imaging was performed for evaluation of myocardial isch aemia in 350 patients (mean age = 60 +/- 13 years, 146 men) without known c oronary artery disease. One hundred and forty-eight patients were hypertens ive. Rest SPECT images were acquired 24 h after the test. Abnormal perfusio n was defined as the presence of reversible or fixed perfusion defects. Results No significant difference was detected between patients with and wi thout hypertension regarding gender, prevalence of symptoms, risk factors, pretest probability of coronary artery disease (52 +/- 28 versus 53 +/- 29% ), peak rate pressure product (21040 +/- 4755 versus 20774 +/- 4865) or num ber of patients achieving the target heart rate during stress (85 versus 86 %). Hypertensive patients were significantly older (62 +/- 11 versus 58 +/- 13 years, P = 0.005) and were receiving beta-blockers more frequently (34 versus 18%, P = 0.0001). The prevalence of myocardial perfusion abnormaliti es was similar in patients with and without hypertension (28 versus 31% in patients with low, 38 versus 33% in patients with intermediate and 60 versu s 58% in patients with high pretest probability of coronary artery disease, respectively). No significant difference was detected between the two grou ps regarding stress perfusion defect score (1.45 +/- 2.5 versus 1.50 +/- 2. 6) or rest score (0.72 +/- 1.8 versus 0.68 +/- 1.6). Conclusion Treated hypertensive patients without known coronary artery dise ase have a similar prevalence and severity of myocardial perfusion abnormal ities at rest and at dobutamine stress compared with normotensive patients with similar clinical characteristics. (C) Lippincott Williams & Wilkins.