Ischemic Heart Disease in the Older Hypertensive Patient

Evaluation and Management
  • Jan Laws Houghton
Chapter
Part of the Clinical Hypertension and Vascular Diseases book series (CHVD)

Abstract

Ischemic heart disease (IHD) is characterized by an imbalance between myocardial blood flow supply and metabolic demand. In Westernized society, this is found principally in the setting of atherosclerotic coronary artery disease (CAD), also known as coronary heart disease (CHD), but is also present in other disease states commonly found in the hypertensive elderly patient, including valvular heart disease, dilated cardiomyopathy, atrial fibrillation (AF), metabolic disorders such as hypothyroidism, left ventricular hypertrophy (LVH), and diastolic dysfunction. In patients with CAD, supply is limited by the degree of luminal narrowing in epicardial coronary vessels. In those with hypertension with or without LVH, excess demand is present owing to increases in wall stress and in metabolic demands of the hypertrophied myocardium. In both of these disorders, there is associated endothelial dysfunction in the coronary microvasculature, which can also limit supply to the myocardium (1). When CAD and hypertension with or without LVH coexist, both supply and demand are adversely affected, thus worsening the degree of expected ischemia.

Keywords

Ischemic Heart Disease Abdominal Aortic Aneurysm Thrombolytic Therapy Systolic Hypertension Chronic Stable Angina 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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Copyright information

© Humana Press Inc., Totowa, NJ 2005

Authors and Affiliations

  • Jan Laws Houghton
    • 1
  1. 1.Division of CardiologyAlbany Medical CollegeAlbany

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