Exercise echocardiography versus exercise electrocardiography in the diagnosis of coronary artery disease in hypertension

In hypertension, coronary artery disease (CAD) can be overestimated by stre ss electrocardiography (ECG) and scintigraphy due to frequent false-positiv e results. Exercise tests are also limited by an excessive blood pressure i ncrease, and pharmacologic pressure normalization decreases the accuracy of the test. The aim of this study was to assess the accuracy of exercise ech ocardiography as an alternative test for CAD detection in hypertension, bot h before and after adequate blood pressure control. We studied 59 hypertens ive and 59 normotensive patients undergoing coronary angiography for chest pain. Upright bicycle exercise ECG and echocardiographic tests were perform ed in each group in the absence of therapy; in hypertensives, the tests wer e repeated a day apart after blood pressure normalization with sublingual n ifedipine. Significant CAD (lumen narrowing >50%) was detected in 22 hypert ensive and 41 normotensive patients. In the two groups, sensitivity, specif icity, and diagnostic accuracy treatment were not statistically different ( 95%, 94%, 94% in hypertensives and 82%, 77%, 83% in normotensives, respecti vely), but were significantly higher than for the exercise ECG test (68%, 7 0%, and 69%, respectively). After blood pressure lowering, exercise echocar diography sensitivity slightly decreased (91%), whereas specificity (100%) and diagnostic accuracy (96%) did not vary; on the contrary, exercise ECG s ensitivity decreased to 45%. Therefore, according to our data, exercise ech ocardiography can be an accurate test and more reliable than exercise ECG t o detect CAD in normotensives as well as in hypertensives. Normalization of blood pressure with nifedipine does not affect its accuracy, but markedly reduces the sensitivity of exercise EGG. (C) 2000 American Journal of Hyper tension, Ltd.