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Risk factors for silent myocardial ischemia in patients with well-controlled essential hypertension

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Abstract

Silent myocardial ischemia (SMI) is frequently observed in patients with essential hypertension (EH). The major risk factor for SMI is uncontrolled blood pressure (BP), but SMI is also observed in patients with well-controlled BP. To evaluate the prevalence of SMI and the factors associated with SMI in EH patients with well-controlled BP. The medical records of 859 EH patients who underwent simultaneous 24-h ambulatory blood pressure monitoring (ABPM) and 24-h ambulatory electrocardiogram recording (AECG) were retrospectively evaluated. Each SMI episode was characterized by: (a) ST segment depression ≥0.5 mm; (b) duration of ST segment depression >60 s; and (c) reversibility of the ST segment depression. Overall 126 EH patients (14.7 %) had at least one episode of SMI. The SMI events were more frequent among patients with poorly controlled compared to those with well-controlled BP [86/479 (17.95 %) vs. 40/380 (10.52 %), p < 0.01]. Among EH patients with well-controlled BP, current and past smoking as well as the presence of an additional metabolic syndrome (MetS) constitutive element (obesity, impaired fasting glucose level or dyslipidemia) were significantly associated with the occurrence of SMI. In all EH patients with well-controlled BP and AECG evidence of SMI, there were one or more coronary artery stenotic lesions greater than 50 % found at coronary angiography. In EH patients who are current smokers, or have one or more additional components of a MetS there is markedly reduced benefit associated with good BP control with regard to the occurrence of myocardial ischemia: in this patient category, an AECG may help detect this condition.

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Acknowledgments

The authors are grateful to the owners and the medical director of the Spinelli Hospital who granted the free use of the facilities and services required to conduct the study. This study was supported by unrestricted grants from Stroder/Società Italiana dell’Osteoporosi del Metabolismo Minerale e delle Malattie dello Scheletro (to DR) and Società Italiana Medicina Interna (to RI).

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Authors and Affiliations

  1. Department of Clinical Medicine and Surgery, Federico II University, Via Pansini 5, 80131, Naples, Italy

    Domenico Rendina, Renato Ippolito, Gianpaolo De Filippo, Riccardo Muscariello, Daniela De Palma, Michele Schiano di Cola, Pasquale Strazzullo & Ferruccio Galletti

  2. Spinelli Hospital, Belvedere Marittimo, Cosenza, Italy

    Domenico Rendina, Silvana De Bonis & Domenico Benvenuto

  3. Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Unité Diabète-Hypertension-Nutrition de l’Adolescent, Le Kremlin-Bicêtre, France

    Gianpaolo De Filippo

  4. Cardiology Unit, Ferrari Hospital, Castrovillari, Cosenza, Italy

    Silvana De Bonis

  5. Department of Advanced Clinical Sciences, Federico II University, Naples, Italy

    Maurizio Galderisi

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  1. Domenico Rendina
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  2. Renato Ippolito
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  4. Riccardo Muscariello
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  6. Silvana De Bonis
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  7. Michele Schiano di Cola
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  9. Maurizio Galderisi
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  10. Pasquale Strazzullo
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  11. Ferruccio Galletti
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Correspondence to Domenico Rendina.

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All the clinical procedures were conducted in accordance with the Declaration of Helsinki on human experimentation. The study protocol has been approved by the Federico II University Hospital Ethical Committee.

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Informed consent was obtained from all individual participants included in the study.

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Rendina, D., Ippolito, R., De Filippo, G. et al. Risk factors for silent myocardial ischemia in patients with well-controlled essential hypertension. Intern Emerg Med 12, 171–179 (2017). https://doi.org/10.1007/s11739-016-1527-2

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