Silent ST depression and cardiovascular end-organ damage in newly found, older hypertensives

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 contrib uting factors in asymptomatic, previously untreated, older hypertensives. F rom a population survey, in 184 patients with mild hypertension (4 times sy stolic blood pressure greater than or equal to 160 mm Hg and/or diastolic b lood pressure greater than or equal to 95 mm Hg), 60 to 75 years of age, ca rdiovascular end-organ damage was measured. Episodes of ST-segment depressi on 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 arteri al plaques as measured by B-mode ultrasound compared with hypertensives wit hout 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 ven tricular mass index was not different (111 +/- 118 versus 104 +/- 24 g/m(2) ; P=0.18, respectively). In hypertensives with transient ST-segment depress ion, a significant relation was found between left ventricular mass and isc hemic burden (r=0.51, P=0.02), Approximately 1 of 8 unselected and previous ly untreated older hypertensives show asymptomatic ST-segment depression, s uggestive of silent myocardial ischemia, These data suggest that vascular f actors mainly determine the occurrence of ischemic ST-segment depression an d cardiac factors determine the ischemic burden in older hypertensives.